Healthcare Provider Details

I. General information

NPI: 1679980098
Provider Name (Legal Business Name): MENDED WING COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N 12TH AVE
PENSACOLA FL
32501-3306
US

IV. Provider business mailing address

1011 N 12TH AVE
PENSACOLA FL
32501-3306
US

V. Phone/Fax

Practice location:
  • Phone: 850-250-1441
  • Fax: 888-745-2296
Mailing address:
  • Phone: 850-250-1441
  • Fax: 888-745-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ELIZABETH JONES
Title or Position: OWNER
Credential: LMHC
Phone: 850-250-1441