Provider Demographics
NPI:1487307534
Name:THE MINDFULNESS GYM LLC
Entity type:Organization
Organization Name:THE MINDFULNESS GYM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-633-8606
Mailing Address - Street 1:10179 POKAGON LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0191
Mailing Address - Country:US
Mailing Address - Phone:248-633-8606
Mailing Address - Fax:248-218-9367
Practice Address - Street 1:36400 WOODWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0913
Practice Address - Country:US
Practice Address - Phone:248-633-8606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty