Provider Demographics
NPI:1922545763
Name:MINDFUL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MINDFUL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:PAULICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-324-1950
Mailing Address - Street 1:1330 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3310
Mailing Address - Country:US
Mailing Address - Phone:772-324-1950
Mailing Address - Fax:
Practice Address - Street 1:1330 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-3310
Practice Address - Country:US
Practice Address - Phone:772-324-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH140752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016815100Medicaid