Provider Demographics
NPI:1265294102
Name:RISE MIND THERAPY LLC
Entity type:Organization
Organization Name:RISE MIND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-680-6581
Mailing Address - Street 1:7940 FRONT BEACH RD STE 95267
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4817
Mailing Address - Country:US
Mailing Address - Phone:305-680-6581
Mailing Address - Fax:
Practice Address - Street 1:6279 ISLAND WAY
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7064
Practice Address - Country:US
Practice Address - Phone:305-990-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty