Mindful River Psychotherapy PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MINDFUL RIVER PSYCHOTHERAPY PLLC

Practice address

808 3Rd Ave S Ste 204
Fargo, ND 58103-1865

Phone

(785) 232-7653

NPI assigned

Sep 10, 2021

Organization subpart

No

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

Authorized official

Name

Danielle Vaughn, LCSW, LICSW

Title

Owner

Phone

(785) 323-7653

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1631232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1265101406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 3RD AVE S STE 204",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031865",
            "telephone_number": "785-232-7653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 3RD AVE S STE 204",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031865",
            "telephone_number": "785-232-7653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL RIVER PSYCHOTHERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-10",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-323-7653",
        "authorized_official_credential": "LCSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taneka Amoya Miller, NP
• Timothy Isaac Miller
• Amna Abraham Millewa
• Carl Millien
• Mindful Balance Therapy, PLLC
• Mindwell Behavioral Health
• Patricia Minihan
• Anthony Minke, NP
• Carlos Daniel Miranda III, M.D.
• Emily Olivia Miranda, APRN,CNP

• Clinical Social Worker in Fargo, ND
• Providers in Fargo, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.