Basic Information
| Provider Information | |||||||||
| NPI: | 1588189948 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIND WORKS COUNSELING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1334 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | TARPON SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346892020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132801636 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2725 PARK DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337631023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132801636 | ||||||||
| FaxNumber: | 5132801636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 08/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | ELLIOTT | ||||||||
| AuthorizedOfficialFirstName: | ALICE | ||||||||
| AuthorizedOfficialMiddleName: | JONES | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 5132801636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH12562 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.