Healthcare Provider Details

I. General information

NPI: 1386199099
Provider Name (Legal Business Name): MEANINGFUL SELF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 METROWEST BLVD STE 202
ORLANDO FL
32835-7638
US

IV. Provider business mailing address

PO BOX 3104
ORLANDO FL
32802-3104
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-2356
  • Fax:
Mailing address:
  • Phone: 407-286-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. MARIBEL NIEVES
Title or Position: MANAGER
Credential: LMHC
Phone: 407-697-3207