Provider Demographics
NPI:1912764697
Name:MENDED MIND THERAPY LLC
Entity Type:Organization
Organization Name:MENDED MIND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-261-4333
Mailing Address - Street 1:7901 4TH ST N STE 18872
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4305
Mailing Address - Country:US
Mailing Address - Phone:772-261-4333
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 18872
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4305
Practice Address - Country:US
Practice Address - Phone:772-261-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)