Organization
MINDFUL THERAPY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA IVONNE BARSOTTI LCSW (CEO)
(626) 893-0480
Entity
Organization
Contact information
Practice address
550 W VISTA WAY STE 107, VISTA, CA 92083-5707
(626) 893-0480
Mailing address
550 W VISTA WAY STE 107, VISTA, CA 92083-5707
(626) 893-0480
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
64017
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4115654
ARTICLES OF INCORPORATION
CA
Enumeration date
03/08/2018
Last updated
03/08/2018
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