Healthcare Provider Details

I. General information

NPI: 1710819081
Provider Name (Legal Business Name): MINDFUL WELLNESS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1313 PONCE DE LEON BLVD STE 301
CORAL GABLES FL
33134-3343
US

IV. Provider business mailing address

1313 PONCE DE LEON BLVD STE 301
CORAL GABLES FL
33134-3343
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-8200
  • Fax:
Mailing address:
  • Phone: 786-521-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE M HERDOCIA
Title or Position: FOUNDER
Credential: LMFT
Phone: 786-521-8200