MEDICARE: UNCLOUDED MIND BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023725520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNCLOUDED MIND BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 958
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-0958
Country	:	US
Telephone Number	:	727-902-4952
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 E LIME ST
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4702
Country	:	US
Telephone Number	:	727-902-4952
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AUNDREA S GUILLAUME-SPONSEL
Credential	:	APRN
Telephone Number	:	727-902-4952

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	11/03/2022

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