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General NPI Number Information
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NPI Number | 1225745425
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Entity Type | Organization
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Legal Business Name | MINDFUL FREEDOM PSYCHOLOGICAL SERVICES CORP
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Dates
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Enumeration Date | 10/28/2022
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 2523 HERSCHEL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4509
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Country | US
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Telephone | 786-868-7017
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Fax |
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Provider Business Mailing Address
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Address Line | 12418 GLENN HOLLOW DR
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City | JACKSONVILLE
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State | FL
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Zip | 32226-2361
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Country | US
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Telephone | 786-868-7017
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LAURA FERNANDEZ
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Credential |
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Telephone | 786-868-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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