Provider Demographics
NPI:1720759954
Name:MINDFUL MEDICAL AND HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MINDFUL MEDICAL AND HEALTH SERVICES LLC
Other - Org Name:IMIND MENTAL HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:KALEL
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MCAP,QS
Authorized Official - Phone:772-497-5985
Mailing Address - Street 1:160 NW CENTRAL PARK PLZ STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1825
Mailing Address - Country:US
Mailing Address - Phone:772-497-5985
Mailing Address - Fax:844-440-1724
Practice Address - Street 1:160 NW CENTRAL PARK PLZ STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1825
Practice Address - Country:US
Practice Address - Phone:772-361-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty