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General NPI Number Information
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NPI Number | 1255154084
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Entity Type | Organization
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Legal Business Name | MINDSOL WELLNESS CENTER LLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 715 N WASHINGTON BLVD STE E
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City | SARASOTA
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State | FL
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Zip | 34236-4256
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Country | US
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Telephone | 941-256-3725
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Fax |
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Provider Business Mailing Address
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Address Line | 715 N WASHINGTON BLVD STE E
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City | SARASOTA
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State | FL
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Zip | 34236-4256
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Country | US
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Telephone | 941-256-3725
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | DR. KIMBERLY S BENSON
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Credential | ED.D
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Telephone | 941-343-7244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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