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General NPI Number Information
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NPI Number | 1710407788
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Entity Type | Organization
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Legal Business Name | MIND/MOOD COUNSELING & COACHING CENTERS OF SWFL PLLC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9990 COCONUT RD # 250
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City | ESTERO
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State | FL
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Zip | 34135-8488
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Country | US
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Telephone | 239-770-7267
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Fax |
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Provider Business Mailing Address
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Address Line | 9990 COCONUT RD # 250
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City | ESTERO
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State | FL
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Zip | 34135-8488
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Country | US
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Telephone | 239-770-7267
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | REGINALD BRUNO
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Credential |
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Telephone | 239-770-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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