Organization
MINDFUL AUTHENTICITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA ORNELAS (BILLING SPECIALIST)
(970) 279-1187
Entity
Organization
Contact information
Practice address
3360 ROAD 12, GREYBULL, WY 82426-9624
(702) 791-1179
(970) 837-3401
Mailing address
1163 BELLEVIEW DR, FORT COLLINS, CO 80526-3840
(307) 213-9484
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
08/25/2022
Last updated
08/07/2024
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