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General NPI Number Information
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NPI Number | 1841996329
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Entity Type | Organization
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Legal Business Name | MINDFULIFE THERAPY
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 690 NE 3RD AVE STE 103
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-3541
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Country | US
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Telephone | 352-477-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 25 N COUNTRY CLUB DR
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-5363
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Country | US
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Telephone | 518-578-7744
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JACINDA LAUNDREE
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Credential | LCSW
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Telephone | 518-578-7744
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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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