Healthcare Provider Details

I. General information

NPI: 1659991925
Provider Name (Legal Business Name): HEALTHY MINDS PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 KALLI CREEK LANE
SAINT AUGUSTINE FL
32080
US

IV. Provider business mailing address

138 SEA GROVE MAIN ST#840133
SAINT AUGUSTINE FL
32080-7743
US

V. Phone/Fax

Practice location:
  • Phone: 785-292-9234
  • Fax:
Mailing address:
  • Phone: 785-292-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINA C STAUBLE
Title or Position: OWNER
Credential: PSY.D
Phone: 785-292-9234