Provider Demographics
NPI:1003680562
Name:MINDFUL MILESTONES THERAPHY
Entity Type:Organization
Organization Name:MINDFUL MILESTONES THERAPHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAIKEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PORTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,APRN,FNP-C,PMHNP
Authorized Official - Phone:305-316-9812
Mailing Address - Street 1:4483 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2563
Mailing Address - Country:US
Mailing Address - Phone:786-975-8577
Mailing Address - Fax:
Practice Address - Street 1:4483 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2563
Practice Address - Country:US
Practice Address - Phone:786-975-8577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty