Healthcare Provider Details

I. General information

NPI: 1770149072
Provider Name (Legal Business Name): MINDFUL AND PRESENT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 MILLENNIUM PKWY STE 116
BRANDON FL
33511-3891
US

IV. Provider business mailing address

1305 RUSTLING OAKS DR
BRANDON FL
33510-2358
US

V. Phone/Fax

Practice location:
  • Phone: 813-455-8672
  • Fax:
Mailing address:
  • Phone: 813-455-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWN MARIE NORTH
Title or Position: OWNER/MANAGING MEMBER
Credential: LCSW
Phone: 813-455-8672