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General NPI Number Information
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NPI Number | 1588189948
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Entity Type | Organization
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Legal Business Name | MIND WORKS COUNSELING LLC
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 2725 PARK DR
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City | CLEARWATER
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State | FL
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Zip | 33763-1023
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Country | US
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Telephone | 513-280-1636
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Fax | 513-280-1636
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Provider Business Mailing Address
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Address Line | 1334 RIVERSIDE DR
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City | TARPON SPRINGS
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State | FL
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Zip | 34689-2020
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Country | US
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Telephone | 513-280-1636
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | ALICE JONES ELLIOTT
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Credential | LMHC
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Telephone | 513-280-1636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH12562
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License Number State | FL
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