Healthcare Provider Details

I. General information

NPI: 1831026970
Provider Name (Legal Business Name): MIND BODY AND SOUL MENTAL HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 WOODLAND RD
PALM SPRINGS FL
33461-1063
US

IV. Provider business mailing address

132 WOODLAND RD
PALM SPRINGS FL
33461-1063
US

V. Phone/Fax

Practice location:
  • Phone: 845-893-5384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNA MCKEAN
Title or Position: OWNER
Credential:
Phone: 845-893-5384