Provider Demographics
NPI:1457994832
Name:MINDFUL SEXUALITY INC
Entity Type:Organization
Organization Name:MINDFUL SEXUALITY INC
Other - Org Name:MICHELLE LOPEZ THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ROXANA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-566-8485
Mailing Address - Street 1:2051 W PRAIRIE CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-3740
Mailing Address - Country:US
Mailing Address - Phone:850-566-8485
Mailing Address - Fax:386-368-7458
Practice Address - Street 1:2051 W PRAIRIE CIR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3740
Practice Address - Country:US
Practice Address - Phone:407-720-9789
Practice Address - Fax:386-368-7458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09928469OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
FLSW16646OtherPROFESSIONAL LICENSE