Healthcare Provider Details

I. General information

NPI: 1093662066
Provider Name (Legal Business Name): MINDFUL HEALING PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SW 46TH TER
CAPE CORAL FL
33914-6028
US

IV. Provider business mailing address

2801 SW 46TH TER
CAPE CORAL FL
33914-6028
US

V. Phone/Fax

Practice location:
  • Phone: 239-497-4898
  • Fax:
Mailing address:
  • Phone: 239-497-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEYSHA KREN
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 239-671-6729