Organization
INTEGRATIVE MINDFULNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHELEEN AVILA M.A. (LICENSED PSYCHOLOGIST)
(612) 872-9231
Entity
Organization
Contact information
Practice address
3608 44TH AVE S, MINNEAPOLIS, MN 55406-2906
(612) 872-9231
(612) 722-3306
Mailing address
3608 44TH AVE S, MINNEAPOLIS, MN 55406-2906
(612) 872-9231
(612) 722-3306
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP 0499
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255305306
INDIVIDUAL NPI
MN
Enumeration date
08/05/2011
Last updated
08/05/2011
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