Provider Demographics
NPI:1467109215
Name:SOUND MIND WELLNESS SERVICES DBA SOUND MIND THERAPY
Entity Type:Organization
Organization Name:SOUND MIND WELLNESS SERVICES DBA SOUND MIND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-877-0416
Mailing Address - Street 1:17716 JAMESTOWN WAY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-7708
Mailing Address - Country:US
Mailing Address - Phone:727-877-0416
Mailing Address - Fax:
Practice Address - Street 1:17716 JAMESTOWN WAY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-7708
Practice Address - Country:US
Practice Address - Phone:727-877-0416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health