| Mindful Journey Therapy Llc | |
|
3441 Colonial Blvd Ste 2&3 Fort Myers FL 33966-1121 | |
| (770) 366-6898 | |
| (239) 800-5145 |
| Full Name | Mindful Journey Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3441 Colonial Blvd Ste 2&3, Fort Myers, Florida |
| Authorized Official Name and Position | Patricia E Sullivan (OWNER) |
| Authorized Official Contact | 7703666898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Journey Therapy Llc 3441 Colonial Blvd Ste 2&3 Fort Myers FL 33966-1121 Ph: (941) 216-6111 | Mindful Journey Therapy Llc 3441 Colonial Blvd Ste 2&3 Fort Myers FL 33966-1121 Ph: (770) 366-6898 |
| NPI Number | 1598473902 |
|---|---|
| Provider Enumeration Date | 11/14/2022 |
| Last Update Date | 04/08/2024 |
| Certification Date | 04/08/2024 |
| Medicare PECOS PAC ID | 0648649335 |
|---|---|
| Medicare Enrollment ID | O20221220002431 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598473902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Patricia Ellen Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053038661 PECOS PAC ID: 1557730249 Enrollment ID: I20221220002497 |
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