| Mindful Behavioral Healthcare, Llc | |
|
717 E Oak St Kissimmee FL 34744-4580 | |
| (407) 846-0533 | |
| (407) 518-1730 |
| Full Name | Mindful Behavioral Healthcare, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 717 E Oak St, Kissimmee, Florida |
| Authorized Official Name and Position | Michelle Missigman (COO) |
| Authorized Official Contact | 3523289139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Behavioral Healthcare, Llc 719 East Oak Street Kissimmee FL 34744 Ph: (407) 846-0533 | Mindful Behavioral Healthcare, Llc 717 E Oak St Kissimmee FL 34744-4580 Ph: (407) 846-0533 |
| NPI Number | 1477744548 |
|---|---|
| Provider Enumeration Date | 08/05/2007 |
| Last Update Date | 01/26/2022 |
| Certification Date | 09/27/2021 |
| Medicare PECOS PAC ID | 7810162740 |
|---|---|
| Medicare Enrollment ID | O20111205000619 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477744548 | NPI | - | NPPES |
| 019725400 | Medicaid | FL | |
| 006520800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Vivian Charneco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144322025 PECOS PAC ID: 4486693850 Enrollment ID: I20050426001106 |
| Provider Name | Antonio J Larranaga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073575320 PECOS PAC ID: 4082621339 Enrollment ID: I20060313000289 |
| Provider Name | Shujen Tan Fernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912304759 PECOS PAC ID: 7911220629 Enrollment ID: I20150106000179 |
| Provider Name | Rosa O Beltre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194765065 PECOS PAC ID: 0143228031 Enrollment ID: I20171228001692 |
| Provider Name | Japhet Gaztambide |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215074331 PECOS PAC ID: 9032022538 Enrollment ID: I20180220002571 |
| Provider Name | Roger I Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730697715 PECOS PAC ID: 7214284181 Enrollment ID: I20180724001027 |
| Provider Name | Ingrid C Encinas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447766480 PECOS PAC ID: 1658618608 Enrollment ID: I20190129001566 |
| Provider Name | Amaya M Vinas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982247003 PECOS PAC ID: 0749605392 Enrollment ID: I20200730001056 |
| Provider Name | Richard P Haig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164196002 PECOS PAC ID: 3779981816 Enrollment ID: I20211005000094 |
| Provider Name | Eduardo Rentas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215997994 PECOS PAC ID: 5193888741 Enrollment ID: I20220329000124 |
| Provider Name | Sophia Fouche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144994682 PECOS PAC ID: 6204218241 Enrollment ID: I20220808000986 |
| Provider Name | Mara-joanne Stephanie Derinor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518675156 PECOS PAC ID: 3476922394 Enrollment ID: I20221215000001 |
| Provider Name | Nuela U Umeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851047559 PECOS PAC ID: 2264891928 Enrollment ID: I20230629000602 |
| Provider Name | Marcio Licurgo De Azevedo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861266074 PECOS PAC ID: 1153771993 Enrollment ID: I20231220001796 |
| Provider Name | Michael Joseph Trainor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467617829 PECOS PAC ID: 5890148845 Enrollment ID: I20240126000771 |
| Provider Name | Deborah Rivera |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780886937 PECOS PAC ID: 7012360928 Enrollment ID: I20240126003086 |
| Provider Name | Johncy Abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912788571 PECOS PAC ID: 9234582172 Enrollment ID: I20240127000010 |
| Provider Name | Angelina Correa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912471830 PECOS PAC ID: 9436592193 Enrollment ID: I20240209000400 |
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