A Mindful Life LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

A MINDFUL LIFE LLC

Practice address

15 S Robinson St
Baltimore, MD 21224-2256

Phone

(301) 758-7038

NPI assigned

Jan 12, 2023

Organization subpart

No

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

Authorized official

Name

Colleen Jordon, LCSW-C

Title

Owner

Phone

(301) 758-7038

Specialties & licenses 1

Addresses

Other identifiers 1

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

• Colleen Faye Parris Jordon, LCSW-C

  • Clinical Social Worker
  • Baltimore, MD
  • NPI 1801487194
  NPD

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1821702879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S ROBINSON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242256",
            "telephone_number": "301-758-7038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S ROBINSON ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242256",
            "telephone_number": "301-758-7038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A MINDFUL LIFE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "JORDON",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-758-7038",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL WORK LICENSE",
            "identifier": "14301",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Baltimore, MD
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.