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General NPI Number Information
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NPI Number | 1265294102
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Entity Type | Organization
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Legal Business Name | RISE MIND THERAPY LLC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 05/03/2025
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Provider Practice Location Address
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Address Line | 6279 ISLAND WAY
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City | MARGATE
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State | FL
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Zip | 33063-7064
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Country | US
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Telephone | 305-990-1330
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Fax |
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Provider Business Mailing Address
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Address Line | 7940 FRONT BEACH RD STE 95267
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-4817
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Country | US
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Telephone | 305-680-6581
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | REYNA LYNN KELLER
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Credential | LCSW
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Telephone | 305-680-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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