=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811088867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDFULNESS C.M.H.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9350 SUNSET DRIVE BLDG #100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-450-8728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9350 SUNSET DRIVE BLDG #100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-450-8728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. AMERICO ROSALES
-----------------------------------------------------
Credential | PHD, LMFT, LCSW
-----------------------------------------------------
Telephone | 305-450-8728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------