Provider Demographics
NPI:1598473902
Name:MINDFUL JOURNEY THERAPY LLC
Entity Type:Organization
Organization Name:MINDFUL JOURNEY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-366-6898
Mailing Address - Street 1:3441 COLONIAL BLVD STE 2&3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1121
Mailing Address - Country:US
Mailing Address - Phone:941-216-6111
Mailing Address - Fax:239-244-1348
Practice Address - Street 1:3441 COLONIAL BLVD STE 2&3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1121
Practice Address - Country:US
Practice Address - Phone:770-366-6898
Practice Address - Fax:239-800-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty