Healthcare Provider Details

I. General information

NPI: 1164189320
Provider Name (Legal Business Name): MIND TO HEART BEHAVIOR HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 GLADES RD STE 419
BOCA RATON FL
33431-7205
US

IV. Provider business mailing address

5550 GLADES RD STE 419
BOCA RATON FL
33431-7205
US

V. Phone/Fax

Practice location:
  • Phone: 561-988-6832
  • Fax:
Mailing address:
  • Phone: 561-988-6832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MABEL CAMEJO
Title or Position: CEO
Credential:
Phone: 305-465-0908