Provider Demographics
NPI:1407516701
Name:MINDFUL BLUJAY THERAPEUTICS LLC
Entity Type:Organization
Organization Name:MINDFUL BLUJAY THERAPEUTICS LLC
Other - Org Name:VENUSIA MARTINEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENUSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-462-3786
Mailing Address - Street 1:4516 E HIGHWAY 20 # 3015
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9755
Mailing Address - Country:US
Mailing Address - Phone:850-462-3786
Mailing Address - Fax:
Practice Address - Street 1:4551 BARRINGTON LN
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8793
Practice Address - Country:US
Practice Address - Phone:850-462-3786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty