| A Change Of Mind, Llc | |
|
5020 Tamiami Trail N Suite 202 Naples FL 34103 | |
| (239) 260-4387 | |
| (844) 715-9627 |
| Full Name | A Change Of Mind, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5020 Tamiami Trail N, Naples, Florida |
| Authorized Official Name and Position | Heidi Ann Wilson (OWNER) |
| Authorized Official Contact | 2392604387 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Change Of Mind, Llc 5020 Tamiami Trail N Suite 202 Naples FL 34103 Ph: (239) 260-4387 | A Change Of Mind, Llc 5020 Tamiami Trail N Suite 202 Naples FL 34103 Ph: (239) 260-4387 |
| NPI Number | 1720526387 |
|---|---|
| Provider Enumeration Date | 02/03/2017 |
| Last Update Date | 01/04/2018 |
| Medicare PECOS PAC ID | 4385927540 |
|---|---|
| Medicare Enrollment ID | O20170213002639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720526387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW9293 (Florida) | Primary |
| 251S00000X | Community/behavioral Health | SW9293 (Florida) | Secondary |
| Provider Name | Heidi Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992020572 PECOS PAC ID: 8325336464 Enrollment ID: I20170309000878 |
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