MEDICARE: OPEN MIND SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518291046	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1285191064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MIND SERVICES INC

Provider Business Mailing Address
First Line	:	1563 WINTERBERRY LN
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-2336
Country	:	US
Telephone Number	:	954-385-9550
Fax Number	:	954-530-1532

Provider Business Practice Location Address
First Line	:	2731 EXECUTIVE PARK DR STE 4
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33331-3619
Country	:	US
Telephone Number	:	954-385-9550
Fax Number	:	954-530-1532

Authorized Official
Title or Position	:	LMHC
Name	:	VALERIA CLAUDIA VILAR
Credential	:
Telephone Number	:	954-385-9550

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/28/2019

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Directions to “OPEN MIND SERVICES INC ” Practice Location

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