| Mindful Psychology And Wellness Center, Inc | |
|
1931 Nw 150th Ave Ste 116 Pembroke Pines FL 33028-2873 | |
| (786) 383-1856 | |
| (786) 431-4872 |
| Full Name | Mindful Psychology And Wellness Center, Inc |
|---|---|
| Speciality | Psychologist |
| Location | 1931 Nw 150th Ave Ste 116, Pembroke Pines, Florida |
| Authorized Official Name and Position | Lisa Davenport (PRESIDENT) |
| Authorized Official Contact | 7863831856 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Psychology And Wellness Center, Inc 1931 Nw 150th Ave Ste 116 Pembroke Pines FL 33028-2873 Ph: (786) 383-1856 | Mindful Psychology And Wellness Center, Inc 1931 Nw 150th Ave Ste 116 Pembroke Pines FL 33028-2873 Ph: (786) 383-1856 |
| NPI Number | 1437822988 |
|---|---|
| Provider Enumeration Date | 07/30/2021 |
| Last Update Date | 07/30/2021 |
| Certification Date | 07/30/2021 |
| Medicare PECOS PAC ID | 3274939103 |
|---|---|
| Medicare Enrollment ID | O20210901001353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437822988 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa Carol T Davenport |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508995432 PECOS PAC ID: 8426454356 Enrollment ID: I20210901001573 |
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