Integrative Mindfulness LLC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

LP 0499 Issued in MN

Legal business name

INTEGRATIVE MINDFULNESS LLC

Practice address

3608 44TH Ave S
Minneapolis, MN 55406-2906

Phone

(612) 872-9231

Fax

(612) 722-3306

NPI assigned

Aug 5, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Katheleen Avila, M.A.NPI 1255305306

Title

Licensed Psychologist

Phone

(612) 872-9231

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Katheleen Avila, M.A. LIC PSYCHOLOGIS

  • Psychologist
  • Minneapolis, MN
  • NPI 1255305306
  NPD (past) Authorized official

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312502400000",
    "number": "1457630634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 44TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062906",
            "telephone_number": "612-872-9231",
            "fax_number": "612-722-3306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 44TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554062906",
            "telephone_number": "612-872-9231",
            "fax_number": "612-722-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MINDFULNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2011-08-05",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "KATHELEEN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "612-872-9231",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "LP 0499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1255305306",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Counseling Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Counseling Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.