Provider Demographics
NPI:1437822988
Name:MINDFUL PSYCHOLOGY AND WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:MINDFUL PSYCHOLOGY AND WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:786-383-1856
Mailing Address - Street 1:1931 NW 150TH AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2873
Mailing Address - Country:US
Mailing Address - Phone:786-383-1856
Mailing Address - Fax:431-487-2786
Practice Address - Street 1:1931 NW 150TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2873
Practice Address - Country:US
Practice Address - Phone:786-383-1856
Practice Address - Fax:786-431-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty