Provider Demographics
NPI:1972386001
Name:MINDFLO THERAPY, LLC
Entity Type:Organization
Organization Name:MINDFLO THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-805-9966
Mailing Address - Street 1:55 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3615
Mailing Address - Country:US
Mailing Address - Phone:616-805-9966
Mailing Address - Fax:
Practice Address - Street 1:55 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3615
Practice Address - Country:US
Practice Address - Phone:616-805-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty