Organization
MINDFULLY, LLC
Active
Parent organization
MINDFULLY, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINDFULLY, LLC
Authorized official
CHARLES K ROBERTS EDD, LPCC-S, LICDC-C (AUTHORIZED OFFICIAL)
(888) 830-0347
Entity
Organization
Contact information
Practice address
2025 GUADALUPE ST STE 260, AUSTIN, TX 78705-5642
(888) 830-0347
Mailing address
1251 NILLES RD STE 5, FAIRFIELD, OH 45014-7205
(888) 830-0347
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
09/23/2022
Last updated
08/06/2024
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