MEDICARE: MINDFREE THERAPY CENTER 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	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1710610456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFREE THERAPY CENTER LLC

Provider Business Mailing Address
First Line	:	2636 OLD OKEECHOBEE RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4129
Country	:	US
Telephone Number	:	855-740-1181
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4803
Country	:	US
Telephone Number	:	855-740-1181
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. BRANDAN FREEMAN
Credential	:
Telephone Number	:	855-740-1181

Provider Enumeration Date	:	07/08/2022
Last Update Date	:	07/08/2022

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