| A Mindful Space Psychotherapy, Llc | |
|
1400 Nw 41st Ct Oakland Park FL 33309-4520 | |
| (954) 574-2013 | |
| Not Available |
| Full Name | A Mindful Space Psychotherapy, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1400 Nw 41st Ct, Oakland Park, Florida |
| Authorized Official Name and Position | Jerrod Johnson (CEO) |
| Authorized Official Contact | 9545742013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Mindful Space Psychotherapy, Llc 1400 Nw 41st Ct Oakland Park FL 33309-4520 Ph: (954) 574-2013 | A Mindful Space Psychotherapy, Llc 1400 Nw 41st Ct Oakland Park FL 33309-4520 Ph: (954) 574-2013 |
| NPI Number | 1851115158 |
|---|---|
| Provider Enumeration Date | 11/13/2024 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Medicare PECOS PAC ID | 3274053830 |
|---|---|
| Medicare Enrollment ID | O20250226000929 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851115158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jerrod K Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780928556 PECOS PAC ID: 4082930938 Enrollment ID: I20150311002367 |
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