Provider Demographics
NPI:1922544063
Name:MIND SPA LLC
Entity Type:Organization
Organization Name:MIND SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-321-9117
Mailing Address - Street 1:3210 66TH ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-7322
Mailing Address - Country:US
Mailing Address - Phone:202-321-9117
Mailing Address - Fax:
Practice Address - Street 1:365 5TH AVE S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6575
Practice Address - Country:US
Practice Address - Phone:239-307-0886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty