Healthcare Provider Details

I. General information

NPI: 1689581613
Provider Name (Legal Business Name): MIND TREE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 GOLDEN BEAK DR FL 33839
EAGLE LAKE FL
33839-5706
US

IV. Provider business mailing address

1907 GOLDEN BEAK DR FL 33839
EAGLE LAKE FL
33839-5706
US

V. Phone/Fax

Practice location:
  • Phone: 863-264-0639
  • Fax:
Mailing address:
  • Phone: 863-264-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NAOMI FIGUEROA
Title or Position: MANAGER
Credential: LCSW
Phone: 863-210-1148