MEDICARE: MINDME 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1518670652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDME LLC

Provider Business Mailing Address
First Line	:	1523 OAK LACE CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2847
Country	:	US
Telephone Number	:	904-571-4102
Fax Number	:	833-624-1727

Provider Business Practice Location Address
First Line	:	10163 FORTUNE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3519
Country	:	US
Telephone Number	:	904-299-5387
Fax Number	:	833-624-1727

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA WHITTINGHILL
Credential	:
Telephone Number	:	904-571-4102

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	12/03/2024

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Directions to “MINDME LLC ” Practice Location

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