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MINDFUL MEDICINE COUNSELING CENTER LLC NPI 1912693912


NPI Information

NPI: 1912693912
Provider Name: MINDFUL MEDICINE COUNSELING CENTER LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 10D2286809

Address:
10365 HOOD RD S STE 204
JACKSONVILLE, FL
ZIP 32257
Phone: (217) 480-7298
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MINDFUL MEDICINE COUNSELING CENTER LLC is a pediatrics in Jacksonville, FL. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. MINDFUL MEDICINE COUNSELING CENTER LLC NPI is 1912693912. The provider is registered as an organization entity type.

The provider's business location address is:

10365 HOOD RD S STE 204
JACKSONVILLE, FL
ZIP 32257-261
Phone: (217) 480-7298

The provider's authorized official is Roman Criollo .
The authorized official title is Coo and has the following contact phone number (217) 480-7298.

The CLIA number assigned to this NPI record is 10D2286809 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/12/2023 and was last updated on 11/3/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthNo
2261QP2300XClinic/CenterPrimary CareNo
3208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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