Mindful Living PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301011430 Issued in MI

Legal business name

MINDFUL LIVING PLLC

Practice address

810 E Grand River Ave Ste 101
Brighton, MI 48116-1878

Phone

(810) 588-4236

Fax

(810) 588-4247

NPI assigned

Jun 30, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Debbie Koeltzow, ED.D., LPNPI 1902004070

Title

Clinic Director

Phone

(734) 657-8059

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debbie Koeltzow, EDD, LP

  • Clinical Psychologist
  • Brighton, MI
  • NPI 1902004070
  Medicare reassignment Care Compare group NPD Authorized official
• Jacqueline Lee Konley, LMSW

  • Clinical Social Worker
  • Brighton, MI
  • NPI 1093247702
  Medicare reassignment Care Compare group NPD
• Beverly Denise Gibson, LMSW

  • Social Worker
  • Ann Arbor, MI
  • NPI 1760879787
  Medicare reassignment NPD
• Michelle Louise Klear, MS. LLPC

  • Counselor
  • Grand Rapids, MI
  • NPI 1710252291
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246320000000",
    "number": "1013145879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 CARRIAGE WAY",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481977423",
            "telephone_number": "734-657-8059",
            "fax_number": "810-588-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E GRAND RIVER AVE STE 101",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481161878",
            "telephone_number": "810-588-4236",
            "fax_number": "810-588-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL LIVING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2009-06-30",
        "status": "A",
        "authorized_official_last_name": "KOELTZOW",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "734-657-8059",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D., LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301011430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee M Miller, LMSW
• Sandra Lynne Miller
• Heather M Milliken, M.S.W., CAADC, SAP
• Mind & Body Counseling & Coaching PLLC
• Mind of My Making Integrative Psychotherapy PLLC
• Paul Alan Miner, PHARMD
• Marcel Jamil Mio, DO
• Mitchell Home Medical, Inc.
• Nicholas James Mitchell, LMSW
• Thomas Scott Mitchell, LMSW

• Psychologist in Brighton, MI
• Providers in Brighton, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.