Provider Demographics
NPI:1073378089
Name:MINDFUL PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:MINDFUL PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CHELESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKES-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-543-3525
Mailing Address - Street 1:1203 SAMBAR CIR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-2293
Mailing Address - Country:US
Mailing Address - Phone:850-543-3525
Mailing Address - Fax:
Practice Address - Street 1:8051 N TAMIAMI TRL STE E6
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2067
Practice Address - Country:US
Practice Address - Phone:850-543-3525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty