Healthcare Provider Details

I. General information

NPI: 1598698896
Provider Name (Legal Business Name): MIND AND BRAIN CLINICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 BROWNWOOD BLVD STE 100
THE VILLAGES FL
32163-2040
US

IV. Provider business mailing address

532 RICHBURG ST
THE VILLAGES FL
32162-6074
US

V. Phone/Fax

Practice location:
  • Phone: 352-492-0156
  • Fax:
Mailing address:
  • Phone: 352-492-0156
  • 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. ROGER MILLER
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 352-492-0156