1336856848 NPI number — MINDFUL CONNECTION INSTITUTE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336856848 NPI number — MINDFUL CONNECTION INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINDFUL CONNECTION INSTITUTE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336856848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44514-0254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-520-2221
Provider Business Mailing Address Fax Number:
330-776-5557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 BOARDMAN CANFIELD RD STE A2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOARDMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-4374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-974-6158
Provider Business Practice Location Address Fax Number:
937-442-0335
Provider Enumeration Date:
11/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TOPFER
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
937-504-1130

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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