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General NPI Number Information
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NPI Number | 1861131583
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Entity Type | Organization
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Legal Business Name | LB MINDFUL WELLNESS LLC
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 7901 4TH ST N STE 300
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 561-493-3212
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Fax |
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Provider Business Mailing Address
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Address Line | 980 N FEDERAL HWY STE 110
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City | BOCA RATON
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State | FL
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Zip | 33432-2704
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Country | US
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Telephone | 303-285-1117
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Fax | 720-562-2940
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Authorized Official
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Title or Position | SOLE-MEMBER
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Name | LYSSA BROOKS
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Credential | PMHNP
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Telephone | 954-600-2756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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