Provider Demographics
NPI:1477214054
Name:UNIQ MIND & WELLNESS LLC
Entity Type:Organization
Organization Name:UNIQ MIND & WELLNESS LLC
Other - Org Name:UNIQ MIND & WELLNESS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORBEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-422-6810
Mailing Address - Street 1:975 IMPERIAL GOLF COURSE BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1088
Mailing Address - Country:US
Mailing Address - Phone:239-422-6810
Mailing Address - Fax:833-818-0145
Practice Address - Street 1:975 IMPERIAL GOLF COURSE BLVD STE 113
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1088
Practice Address - Country:US
Practice Address - Phone:239-422-6810
Practice Address - Fax:833-818-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114829900Medicaid