Provider Demographics
NPI:1255154084
Name:MINDSOL WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MINDSOL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:941-343-7244
Mailing Address - Street 1:715 N WASHINGTON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4256
Mailing Address - Country:US
Mailing Address - Phone:941-256-3725
Mailing Address - Fax:
Practice Address - Street 1:715 N WASHINGTON BLVD STE E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4256
Practice Address - Country:US
Practice Address - Phone:941-256-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health