Provider Demographics
NPI:1487462693
Name:MINDFUL THERAPY SERVICES
Entity type:Organization
Organization Name:MINDFUL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-458-5891
Mailing Address - Street 1:478 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1331
Mailing Address - Country:US
Mailing Address - Phone:818-458-5891
Mailing Address - Fax:
Practice Address - Street 1:478 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1331
Practice Address - Country:US
Practice Address - Phone:818-458-5891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty