=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740131689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND GROWTH CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2026
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1451 AVE ASHFORD
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00907-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-413-4429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 CALLE 1 APT 4B
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00969-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-413-4429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER/OWNER
-----------------------------------------------------
Name | MISS JOCELYN MORELL CASELLAS
-----------------------------------------------------
Credential | M. PSY.
-----------------------------------------------------
Telephone | 787-413-4429
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------