| Change Of Mind Llc | |
|
314 N.w. Bethany Dr Port St Lucie FL 34986 | |
| (772) 284-6030 | |
| (772) 252-5746 |
| Full Name | Change Of Mind Llc |
|---|---|
| Speciality | Counselor |
| Location | 314 N.w. Bethany Dr, Port St Lucie, Florida |
| Authorized Official Name and Position | Eric R Leever (OWNER) |
| Authorized Official Contact | 7722846030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Change Of Mind Llc 314 N.w. Bethany Dr Port St Lucie FL 34986 Ph: (772) 284-6030 | Change Of Mind Llc 314 N.w. Bethany Dr Port St Lucie FL 34986 Ph: (772) 284-6030 |
| NPI Number | 1811443195 |
|---|---|
| Provider Enumeration Date | 08/28/2016 |
| Last Update Date | 12/20/2018 |
| Medicare PECOS PAC ID | 4284971672 |
|---|---|
| Medicare Enrollment ID | O20190123001743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811443195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH10303 (Florida) | Primary |
| Provider Name | Edward Devaney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558428169 PECOS PAC ID: 6709063027 Enrollment ID: I20190213002202 |
| Provider Name | Bettie A Gerard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528140811 PECOS PAC ID: 1951352764 Enrollment ID: I20190312002221 |
| Provider Name | Tracy Hogan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730746108 PECOS PAC ID: 5496180945 Enrollment ID: I20200110001979 |
| Provider Name | Tiffany Rodgers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437583580 PECOS PAC ID: 5597123075 Enrollment ID: I20231011003590 |
| Provider Name | Eric R Leever |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699962068 PECOS PAC ID: 7416294806 Enrollment ID: I20240319003758 |
| Provider Name | Connie J King |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508318049 PECOS PAC ID: 2567824063 Enrollment ID: I20240410000560 |
| Provider Name | Keith Lafountain |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1235873233 PECOS PAC ID: 2769821321 Enrollment ID: I20240415003753 |
| Provider Name | Kimberly Carter-williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801217252 PECOS PAC ID: 1355780602 Enrollment ID: I20240418003329 |
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