MEDICARE: SOUNDMIND COUNSELING & CONSULTING SERVICES, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972292076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUNDMIND COUNSELING & CONSULTING SERVICES, LLC.

Provider Business Mailing Address
First Line	:	2571 N TOLEDO BLADE BLVD UNIT 2
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9351
Country	:	US
Telephone Number	:	407-270-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2571 N TOLEDO BLADE BLVD UNIT 2
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9351
Country	:	US
Telephone Number	:	407-270-2491
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELISA AMARIS NILES THORNE
Credential	:	LMHC
Telephone Number	:	407-270-2491

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	05/04/2023

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