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General NPI Number Information
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NPI Number | 1093500787
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Entity Type | Organization
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Legal Business Name | MIND MECHANIC MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N # 25598
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 786-487-2612
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N # 25598
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 786-487-2612
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIEL ROUSSEAU
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Credential | PMHNP-C
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Telephone | 786-563-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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