Provider Demographics
NPI:1760077390
Name:MINDGROWTH COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:MINDGROWTH COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:UGALDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:813-527-6420
Mailing Address - Street 1:2694 COCO PALM CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4029
Mailing Address - Country:US
Mailing Address - Phone:813-527-6420
Mailing Address - Fax:
Practice Address - Street 1:2694 COCO PALM CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-4029
Practice Address - Country:US
Practice Address - Phone:813-527-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty