Provider Demographics
NPI:1871316919
Name:MINDFUL PSYCHOTHERAPEUTICS
Entity type:Organization
Organization Name:MINDFUL PSYCHOTHERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRELLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH, NCC
Authorized Official - Phone:302-827-3863
Mailing Address - Street 1:19847 JOHN J WILLIAMS HWY
Mailing Address - Street 2:SUITE 213
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971
Mailing Address - Country:US
Mailing Address - Phone:302-827-3863
Mailing Address - Fax:
Practice Address - Street 1:19847 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 213
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971
Practice Address - Country:US
Practice Address - Phone:302-827-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)