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General NPI Number Information
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NPI Number | 1851281927
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Entity Type | Organization
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Legal Business Name | MINDFUL GRACE WELLNESS LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 108 BLACKJACK CIR
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City | PALATKA
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State | FL
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Zip | 32177
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Country | US
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Telephone | 386-385-8460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 758
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City | HOLLISTER
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State | FL
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Zip | 32147-0758
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP-C, OWNER
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Name | ROSALEE PEREZ-TEEL
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Credential | APRN
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Telephone | 386-546-3190
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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 |
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License Number State |
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