Provider Demographics
NPI:1811639743
Name:MINDSPA, LLC
Entity type:Organization
Organization Name:MINDSPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNOX
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNP
Authorized Official - Phone:561-576-9404
Mailing Address - Street 1:3469 W BOYNTON BEACH BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4639
Mailing Address - Country:US
Mailing Address - Phone:561-576-9404
Mailing Address - Fax:561-493-3483
Practice Address - Street 1:3469 W BOYNTON BEACH BLVD STE 18
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4639
Practice Address - Country:US
Practice Address - Phone:561-576-9404
Practice Address - Fax:561-493-3483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)