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General NPI Number Information
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NPI Number | 1801331459
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Entity Type | Organization
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Legal Business Name | MINDFUL JOURNEY CENTER, LLC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 212 SE 8TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1006
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Country | US
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Telephone | 954-376-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 13453 NW 5TH PL
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City | PLANTATION
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State | FL
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Zip | 33325-6149
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Country | US
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Telephone | 954-376-0496
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | IRENE RODRIGUEZ
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Credential | LMHC
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Telephone | 954-376-0496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MH13060
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License Number State | FL
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