NPIMap

Organization Active NPI

Mindful Behavior Support Inc

  • Specialist
  • Eugene, OR
National Provider Identifier
1154983765
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MINDFUL BEHAVIOR SUPPORT INC
Practice address
492 E 13TH Ave
Eugene, OR 97401-4268
Phone
(541) 520-6440
NPI assigned
Jul 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Authorized official

Name
Jennifer Wells, PH.D.NPI 1982059606
Title
President
Phone
(541) 520-6440

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

492 E 13TH Ave
Eugene, OR 97401-4268

Mailing address

PO Box 210
Dexter, OR 97431-0210
Phone (541) 520-6440

Other names 2

  • Mindful Behavior Support Inc Doing business as
  • Pro Support On-Demand Inc Former legal business name

National Provider Directory

National Provider Directory

Locations

492 E 13th Ave
Eugene, OR 97401
Phone (541) 229-2625

Practitioners & affiliated clinicians

Practitioners 1

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": "1562112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562112000000",
    "number": "1154983765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 210",
            "city": "DEXTER",
            "state": "OR",
            "postal_code": "974310210",
            "telephone_number": "541-520-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "492 E 13TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974014268",
            "telephone_number": "541-520-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIOR SUPPORT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-03",
        "last_updated": "2019-07-03",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "541-520-6440",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mindful Behavior Support Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pro Support On-Demand Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.