Healthcare Provider Details

I. General information

NPI: 1629863949
Provider Name (Legal Business Name): THE MIND STUDIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SW CAMDEN AVE
STUART FL
34994-2924
US

IV. Provider business mailing address

1419 NE OAK BLUFF LN
JENSEN BEACH FL
34957-6520
US

V. Phone/Fax

Practice location:
  • Phone: 772-218-0675
  • Fax:
Mailing address:
  • Phone: 305-725-9719
  • Fax: 305-725-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIA ISABEL PEREZ
Title or Position: OWNER, PSYCHOTHERAPIST
Credential: LMHC
Phone: 305-725-9719