Healthcare Provider Details

I. General information

NPI: 1376187807
Provider Name (Legal Business Name): MINDFUL THERAPIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S OLIVE AVE
WEST PALM BEACH FL
33401-7726
US

IV. Provider business mailing address

2721 MISTY OAKS CIR
ROYAL PALM BEACH FL
33411-6809
US

V. Phone/Fax

Practice location:
  • Phone: 561-287-0942
  • Fax:
Mailing address:
  • Phone: 561-287-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: IVONA BHADHA
Title or Position: LCSW/OWNER
Credential:
Phone: 561-287-0942