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General NPI Number Information
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NPI Number | 1003320524
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Entity Type | Organization
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Legal Business Name | MINDFUL SOLUTIONS THERAPY, LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 4532 TAMIAMI TRL E STE 302
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City | NAPLES
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State | FL
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Zip | 34112-6784
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Country | US
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Telephone | 239-307-8038
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 WILDWOOD LAKES BLVD UNIT 2
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City | NAPLES
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State | FL
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Zip | 34104-6457
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Country | US
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Telephone | 239-307-8038
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | KRISTINA L KARDANOW
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Credential | LCSW
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Telephone | 239-307-8038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11649
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License Number State | FL
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