Healthcare Provider Details

I. General information

NPI: 1992573166
Provider Name (Legal Business Name): WELLNESS MINDSET COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 HAMLIN AVE UNIT G
SAINT CLOUD FL
34771-8590
US

IV. Provider business mailing address

1427 BELLADONNA PL # 1018
SAINT CLOUD FL
34771-5813
US

V. Phone/Fax

Practice location:
  • Phone: 407-676-4276
  • Fax:
Mailing address:
  • Phone: 954-465-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EKIBA AYISHA SMITH
Title or Position: OWNER
Credential:
Phone: 407-676-4276