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General NPI Number Information
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NPI Number | 1700778263
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Entity Type | Organization
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Legal Business Name | EVOLVING MIND THERAPY
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 688 FORREST DR APT 2
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City | MIAMI SPRINGS
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State | FL
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Zip | 33166-7261
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Country | US
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Telephone | 305-793-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 688 FORREST DR APT 2
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City | MIAMI SPRINGS
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State | FL
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Zip | 33166-7261
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Country | US
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Telephone | 305-793-0048
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | NATHALIE VEGA
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Credential |
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Telephone | 305-793-0048
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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 |
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License Number State |
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