| Mindful Performance Therapy, Pllc | |
|
1414 Trade Center Dr Ste 26-e Traverse City MI 49696-8944 | |
| (989) 370-0703 | |
| Not Available |
| Full Name | Mindful Performance Therapy, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1414 Trade Center Dr Ste 26-e, Traverse City, Michigan |
| Authorized Official Name and Position | Diana Volant (OWNER) |
| Authorized Official Contact | 9893700703 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Performance Therapy, Pllc 1414 Trade Center Dr Ste 26-e Traverse City MI 49696-8944 Ph: (989) 370-0703 | Mindful Performance Therapy, Pllc 1414 Trade Center Dr Ste 26-e Traverse City MI 49696-8944 Ph: (989) 370-0703 |
| NPI Number | 1851972814 |
|---|---|
| Provider Enumeration Date | 04/20/2021 |
| Last Update Date | 01/07/2022 |
| Certification Date | 01/07/2022 |
| Medicare PECOS PAC ID | 6800299728 |
|---|---|
| Medicare Enrollment ID | O20210729000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851972814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Diana F Volant |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1164760856 PECOS PAC ID: 7618370537 Enrollment ID: I20210729000428 |
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