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General NPI Number Information
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NPI Number | 1689498966
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Entity Type | Organization
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Legal Business Name | MINDFUL PATHWAYS PSYCHIATRY
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 520 E CHURCH ST APT 930
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City | ORLANDO
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State | FL
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Zip | 32801-3157
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Country | US
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Telephone | 786-337-5715
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E CHURCH ST APT 930
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City | ORLANDO
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State | FL
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Zip | 32801-3157
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Country | US
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Telephone | 786-337-5715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THEOTIS CHAPPELL JR.
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Credential | APRN
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Telephone | 786-337-5715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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