Provider Demographics
NPI:1275013542
Name:BEAUTIFUL MIND BEHAVIORAL SERVICES, CORP.
Entity Type:Organization
Organization Name:BEAUTIFUL MIND BEHAVIORAL SERVICES, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEYSI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-313-0049
Mailing Address - Street 1:1137 BARTOW RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5828
Mailing Address - Country:US
Mailing Address - Phone:863-313-0049
Mailing Address - Fax:863-248-1970
Practice Address - Street 1:1137 BARTOW RD STE A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5828
Practice Address - Country:US
Practice Address - Phone:863-313-0049
Practice Address - Fax:863-248-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health