=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023833845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLOURISHING MINDS THERAPY AND COACHING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 TEN ROD RD
-----------------------------------------------------
City | NORTH KINGSTOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02852-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-684-0529
-----------------------------------------------------
Fax | 401-247-8379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 207 BROADWAY APT 201
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02840-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-751-1188
-----------------------------------------------------
Fax | 401-247-8379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LMFT
-----------------------------------------------------
Name | TIFFANY KAELIN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 203-751-1188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------