Healthcare Provider Details

I. General information

NPI: 1871240317
Provider Name (Legal Business Name): MINDFUL HEART ORGANIZATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5897 LITTLE LEAF CT
MILTON FL
32570-3501
US

IV. Provider business mailing address

5897 LITTLE LEAF CT
MILTON FL
32570-3501
US

V. Phone/Fax

Practice location:
  • Phone: 850-490-7829
  • Fax:
Mailing address:
  • Phone: 850-490-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC D WHITTLESAY JR.
Title or Position: OWNER
Credential: LMHC
Phone: 850-490-7829