Healthcare Provider Details

I. General information

NPI: 1790615284
Provider Name (Legal Business Name): MOOD AND MIND COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 PASADENA AVE S STE 330
SOUTH PASADENA FL
33707-4567
US

IV. Provider business mailing address

1615 PASADENA AVE S STE 330
SOUTH PASADENA FL
33707-4567
US

V. Phone/Fax

Practice location:
  • Phone: 727-314-2066
  • Fax:
Mailing address:
  • Phone: 727-314-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARA CANCIO
Title or Position: THERAPIST
Credential: LLC
Phone: 727-314-2066