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General NPI Number Information
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NPI Number | 1023725520
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Entity Type | Organization
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Legal Business Name | UNCLOUDED MIND BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 850 E LIME ST
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-4702
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Country | US
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Telephone | 727-902-4952
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 958
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-0958
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Country | US
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Telephone | 727-902-4952
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUNDREA S GUILLAUME-SPONSEL
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Credential | APRN
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Telephone | 727-902-4952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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