Mindful Behavioral, Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MINDFUL BEHAVIORAL, INC

Practice address

2712 Middleburg Dr
Suite 105
Columbia, SC 29204-2415

Phone

(803) 569-1789

NPI assigned

Feb 4, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jomoyatta Akila Proctor

Title

Ceo

Phone

(919) 697-0767

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Mindful Behavioral2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mindful Behavioral

  • Community/Behavioral Health Agency
  • North Charleston, SC
  • NPI 1891108320
  NPD tax ID

Locations

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

{
    "created_epoch": "1359936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1811236342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 MIDDLEBURG DR",
            "address_2": "SUITE 105",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042415",
            "telephone_number": "803-569-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2712 MIDDLEBURG DR",
            "address_2": "SUITE 105",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292042415",
            "telephone_number": "803-569-1789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIORAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-04",
        "last_updated": "2016-01-27",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "JOMOYATTA",
        "authorized_official_middle_name": "AKILA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-697-0767",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159 BHS",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kennedi Mincey
• Mary Renee Mincey, LPC
• Mind Haven Psychiatry
• Mindful Authority
• Mindful Behavioral, Inc
• Mindful Clinic
• Erin Mines, RBT
• Balbir Singh Minhas, MD
• Patrick Minnick
• Demerise Ott Minor, FNP

• Community/Behavioral Health Agency in Columbia, SC
• Providers in Columbia, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; 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.