Healthcare Provider Details

I. General information

NPI: 1093621310
Provider Name (Legal Business Name): LOVE YOUR BEAUTIFUL MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 67TH AVE S
ST PETERSBURG FL
33712-5812
US

IV. Provider business mailing address

2155 67TH AVE S
ST PETERSBURG FL
33712-5812
US

V. Phone/Fax

Practice location:
  • Phone: 727-900-8991
  • Fax:
Mailing address:
  • Phone: 727-900-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: EBONY GREEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-900-8991