Mindful and Well
Organization Active NPI Mental Health Counselor · Shipshewana, IN
NPI 1982391157 · NPPES record last updated Dec 18, 2023
Key facts
- NPI
- 1982391157
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- MINDFUL AND WELL
- Practice address
- 505 E North Village Dr
Shipshewana, IN 46565-8662 - Phone
- (260) 383-2322
- Fax
- (260) 383-2422
- NPI assigned
- Apr 19, 2023
- Organization subpart
- No
Authorized official
- Name
- Dora Martin-Eash, LCSW
- Title
- Owner
- Phone
- (260) 383-2322
Practitioners 1
-
Dora Martin-Eash, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240113000174 | IN | Part B Supplier - Clinic/Group Practice | 6204288301 |
Receives reassigned benefits from 1 practitioner Practice locations: Shipshewana, IN |
National Provider Directory
Locations
505 E North Village Dr
Shipshewana, IN 46565
Phone (260) 383-2322
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes |
Addresses
Primary practice location
505 E North Village Dr
Shipshewana, IN 46565-8662
Mailing address
5955 N 1120 W
Middlebury, IN 46540-9386
Phone (260) 383-2322
Other providers in Shipshewana, IN
- Erin Marie Kline
- Crystal Maggard
- Dora Martin-Eash
- Stephanie Lynne McNamara
- Midwest Eye Consultants, P.C.
- Optometric Associates of South Bend
- Thomas Anthony Pechin II
- Premise Health of Indiana Medical PC
- Renew Hope Counseling Inc
- Charlene Jean Roth
All providers in Shipshewana, IN · Mental Health Counselor in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.