Provider Demographics
NPI:1063797371
Name:MINDFUL EXCHANGES, PC
Entity type:Organization
Organization Name:MINDFUL EXCHANGES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:OHS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-745-7799
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0446
Mailing Address - Country:US
Mailing Address - Phone:907-745-7799
Mailing Address - Fax:907-745-7799
Practice Address - Street 1:349 E COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6404
Practice Address - Country:US
Practice Address - Phone:907-745-7799
Practice Address - Fax:907-745-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLCSW 5621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty