MEDICARE: MJ HEALTHY MIND THERAPY SOLUTIONS, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1720794993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJ HEALTHY MIND THERAPY SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	15406 MILLER CREEK DR
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-0253
Country	:	US
Telephone Number	:	609-346-0957
Fax Number	:

Provider Business Practice Location Address
First Line	:	15406 MILLER CREEK DR
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-0253
Country	:	US
Telephone Number	:	609-346-0957
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MANAMI JACKSON
Credential	:	LCSW
Telephone Number	:	609-346-0957

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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