Provider Demographics
NPI:1336806819
Name:HEALTHY MIND THERAPY, LLC
Entity Type:Organization
Organization Name:HEALTHY MIND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSCA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-371-9844
Mailing Address - Street 1:7205 RIVERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6793
Mailing Address - Country:US
Mailing Address - Phone:407-371-9844
Mailing Address - Fax:
Practice Address - Street 1:7205 RIVERBROOK CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-6793
Practice Address - Country:US
Practice Address - Phone:407-371-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty