Provider Demographics
NPI:1225780794
Name:MINDFLOW, LLC
Entity Type:Organization
Organization Name:MINDFLOW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTOK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-287-6624
Mailing Address - Street 1:2430 VANDERBILT BEACH RD STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2654
Mailing Address - Country:US
Mailing Address - Phone:239-287-6624
Mailing Address - Fax:
Practice Address - Street 1:10681 AIRPORT PULLING RD N STE 24
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-7332
Practice Address - Country:US
Practice Address - Phone:239-287-6624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty