Provider Demographics
NPI:1821718529
Name:INNOVATION MIND AND HEALTH LLC
Entity Type:Organization
Organization Name:INNOVATION MIND AND HEALTH LLC
Other - Org Name:INNOVATION MIND HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC- PHD
Authorized Official - Phone:407-744-5447
Mailing Address - Street 1:1257 SPOKANE PT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6437
Mailing Address - Country:US
Mailing Address - Phone:407-744-5447
Mailing Address - Fax:
Practice Address - Street 1:2263 VILLA VERANO WAY APT 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5982
Practice Address - Country:US
Practice Address - Phone:407-744-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health