| Mindfulness Based Interventions Llc | |
|
380 Sherman St Ridgway CO 81432-5055 | |
| (970) 318-0529 | |
| (855) 403-3931 |
| Full Name | Mindfulness Based Interventions Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 380 Sherman St, Ridgway, Colorado |
| Authorized Official Name and Position | Nichole Moorman (MENTAL HEALTH CLINICIAN) |
| Authorized Official Contact | 9703180529 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindfulness Based Interventions Llc Po Box 12 Ouray CO 81427-0012 Ph: (970) 318-0529 | Mindfulness Based Interventions Llc 380 Sherman St Ridgway CO 81432-5055 Ph: (970) 318-0529 |
| NPI Number | 1639689938 |
|---|---|
| Provider Enumeration Date | 10/02/2017 |
| Last Update Date | 02/22/2022 |
| Certification Date | 02/22/2022 |
| Medicare PECOS PAC ID | 2961762547 |
|---|---|
| Medicare Enrollment ID | O20180130000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639689938 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | CSW.00001565 (Colorado) | Primary |
| Provider Name | Nichole L Moorman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053554964 PECOS PAC ID: 2163554403 Enrollment ID: I20100721000830 |
| Provider Name | Audra D Duke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447408240 PECOS PAC ID: 1052758760 Enrollment ID: I20240318001026 |
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