MEDICARE: MINDFUL SPROUTS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	106E00000X	Assistant Behavior Analyst
3	106S00000X	Behavior Technician
4	225X00000X	Occupational Therapist
5	235Z00000X	Speech-Language Pathologist
6	103K00000X	Behavior Analyst

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	:	1326505751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL SPROUTS LLC

Provider Business Mailing Address
First Line	:	1251 SW 11TH TER
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-5407
Country	:	US
Telephone Number	:	561-414-5503
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD STE 100C
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3403
Country	:	US
Telephone Number	:	954-248-1171
Fax Number	:	954-248-1617

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. CAMILA MOLINA
Credential	:	LMHC, BCBA
Telephone Number	:	561-414-5503

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	11/20/2023

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Directions to “MINDFUL SPROUTS LLC ” Practice Location

Language	Start Address	Practice Location

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