Healthcare Provider Details

I. General information

NPI: 1679375661
Provider Name (Legal Business Name): MINDFUL CLARITY PSYCHIATRIC SOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 SHERWOOD FOREST DR
ORANGE CITY FL
32763-6355
US

IV. Provider business mailing address

2060 SHERWOOD FOREST DR
ORANGE CITY FL
32763-6355
US

V. Phone/Fax

Practice location:
  • Phone: 407-453-3506
  • Fax:
Mailing address:
  • Phone: 407-453-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW THOMAS LEBRON
Title or Position: MANAGER
Credential: APRN
Phone: 407-453-3506