Provider Demographics
NPI:1588189948
Name:MIND WORKS COUNSELING LLC
Entity Type:Organization
Organization Name:MIND WORKS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:513-280-1636
Mailing Address - Street 1:1334 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2020
Mailing Address - Country:US
Mailing Address - Phone:513-280-1636
Mailing Address - Fax:
Practice Address - Street 1:2725 PARK DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1023
Practice Address - Country:US
Practice Address - Phone:513-280-1636
Practice Address - Fax:513-280-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty