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General NPI Number Information
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NPI Number | 1538886643
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Entity Type | Organization
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Legal Business Name | PRESENT MIND LLC
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 15050 ELDERBERRY LN STE 6-7
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City | FORT MYERS
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State | FL
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Zip | 33907-8504
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Country | US
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Telephone | 914-325-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 10645 AREUM PL UNIT 308
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City | FORT MYERS
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State | FL
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Zip | 33966-1484
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED
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Name | VANESSA NANK
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Credential |
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Telephone | 206-590-5767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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