Provider Demographics
NPI:1336408731
Name:MINDFUL SOLUTIONS COUNSELING SERVICES
Entity Type:Organization
Organization Name:MINDFUL SOLUTIONS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-303-6827
Mailing Address - Street 1:1633 VILLAGE CENTER DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2870
Mailing Address - Country:US
Mailing Address - Phone:860-303-6827
Mailing Address - Fax:860-303-6827
Practice Address - Street 1:1633 VILLAGE CENTER DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2870
Practice Address - Country:US
Practice Address - Phone:860-303-6827
Practice Address - Fax:863-937-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 105051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty