Provider Demographics
NPI:1831858497
Name:THE MINDFUL PRACTICE, LLC
Entity type:Organization
Organization Name:THE MINDFUL PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-308-2747
Mailing Address - Street 1:1133 LOUISIANA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2350
Mailing Address - Country:US
Mailing Address - Phone:407-308-2747
Mailing Address - Fax:321-413-5886
Practice Address - Street 1:1133 LOUISIANA AVE STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2350
Practice Address - Country:US
Practice Address - Phone:407-308-2747
Practice Address - Fax:321-413-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW16166OtherLICENSE NUMBER
FL1588163679OtherNPI