Healthcare Provider Details

I. General information

NPI: 1043085103
Provider Name (Legal Business Name): VIBEWELL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 HIGHLAND ST
COCOA FL
32922-7523
US

IV. Provider business mailing address

126 HIGHLAND ST
COCOA FL
32922-7523
US

V. Phone/Fax

Practice location:
  • Phone: 786-361-8227
  • Fax:
Mailing address:
  • Phone: 786-361-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE CHAFFARDET
Title or Position: SOLE MEMBER
Credential: LMFT
Phone: 305-970-5519