Healthcare Provider Details

I. General information

NPI: 1982445367
Provider Name (Legal Business Name): MINDFUL HARMONY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W SAMPLE RD STE 112P
COCONUT CREEK FL
33073-3457
US

IV. Provider business mailing address

4400 W SAMPLE RD STE 112P
COCONUT CREEK FL
33073-3457
US

V. Phone/Fax

Practice location:
  • Phone: 561-215-9959
  • Fax: 561-461-6238
Mailing address:
  • Phone: 561-215-9959
  • Fax: 561-516-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY WALTER
Title or Position: PRESIDENT/APRN
Credential: APRN
Phone: 561-215-9959