Provider Demographics
NPI:1972095412
Name:MINDFUL THERAPY LLC
Entity Type:Organization
Organization Name:MINDFUL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LECSY
Authorized Official - Middle Name:TANIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-344-8757
Mailing Address - Street 1:770 PONCE DE LEON BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2069
Mailing Address - Country:US
Mailing Address - Phone:786-344-8757
Mailing Address - Fax:786-221-4447
Practice Address - Street 1:770 PONCE DE LEON BLVD STE 307
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2069
Practice Address - Country:US
Practice Address - Phone:786-344-8757
Practice Address - Fax:786-221-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15891101YM0800X
251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health