NPIMap

Organization Active NPI

Mindful Mountain Wellness Center

  • Child & Adolescent Psychiatry Physician
  • Roanoke, VA
National Provider Identifier
1083453161
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
MINDFUL MOUNTAIN WELLNESS CENTER
Practice address
3140 Chaparral Dr Ste 109C
Roanoke, VA 24018-4355
Phone
(540) 792-3872
Fax
(540) 767-6555
NPI assigned
May 20, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

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

Authorized official

Name
Dr. Ryan Matthew White, DONPI 1487000923
Title
Psychiatrist
Phone
(210) 315-5629

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X Primary

Addresses

Primary practice location

3140 Chaparral Dr Ste 109C
Roanoke, VA 24018-4355

Mailing address

3140 Chaparral Dr Ste 109C
Roanoke, VA 24018-4355
Phone (540) 792-3872

Other practice location 1

4734 Hickory Hill Dr
Roanoke, VA 24018-7430
Phone (210) 315-5629

National Provider Directory

National Provider Directory

Locations

2014 Memorial Ave SW
Roanoke, VA 24015

3140 Chaparral Dr
Ste 109C
Roanoke, VA 24018
Phone (540) 792-3872

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769990400000",
    "number": "1083453161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3140 CHAPARRAL DR STE 109C",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184355",
            "telephone_number": "540-792-3872",
            "fax_number": "540-767-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3140 CHAPARRAL DR STE 109C",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184355",
            "telephone_number": "540-792-3872",
            "fax_number": "540-767-6555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4734 Hickory Hill Dr",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240187430",
            "country_code": "US",
            "telephone_number": "210-315-5629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MINDFUL MOUNTAIN WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "210-315-5629",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.