Mindful Heart Therapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MINDFUL HEART THERAPY, LLC

Practice address

7071 S 13TH St Ste 100
Oak Creek, WI 53154-1466

Phone

(414) 502-8762

NPI assigned

Dec 7, 2023

Last updated

May 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kelly StewartNPI 1316189806

Title

Therapist and Owner

Phone

(515) 480-8265

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Marie Stewart, LISW

  • Clinical Social Worker
  • Oak Creek, WI
  • NPI 1316189806
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1063289270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 PARKWAY DR",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7071 S 13TH ST STE 100",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531541466",
            "telephone_number": "414-502-8762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL HEART THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "THERAPIST AND OWNER",
        "authorized_official_telephone_number": "515-480-8265"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Oak Creek, WI
• Providers in Oak Creek, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.