Healthcare Provider Details

I. General information

NPI: 1629530480
Provider Name (Legal Business Name): ENLIGHTENED MIND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3038 N FEDERAL HWY UPPR F2
FORT LAUDERDALE FL
33306-1436
US

IV. Provider business mailing address

3038 N FEDERAL HWY UPPR F2
FORT LAUDERDALE FL
33306-1436
US

V. Phone/Fax

Practice location:
  • Phone: 954-668-9501
  • Fax:
Mailing address:
  • Phone: 954-668-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GURGEL
Title or Position: OWNER
Credential: LMHC
Phone: 954-668-9501