| Mindfully, Llc | |
|
10151 Deerwood Park Blvd Ste 250 Jacksonville FL 32256-0566 | |
| (888) 830-0347 | |
| (513) 939-0310 |
| Full Name | Mindfully, Llc |
|---|---|
| Speciality | Counselor |
| Location | 10151 Deerwood Park Blvd Ste 250, Jacksonville, Florida |
| Authorized Official Name and Position | Charles K Roberts (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8888300347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindfully, Llc 1251 Nilles Rd Ste 5 Fairfield OH 45014-7205 Ph: (888) 830-0347 | Mindfully, Llc 10151 Deerwood Park Blvd Ste 250 Jacksonville FL 32256-0566 Ph: (888) 830-0347 |
| NPI Number | 1376271981 |
|---|---|
| Provider Enumeration Date | 08/11/2022 |
| Last Update Date | 08/06/2024 |
| Certification Date | 08/06/2024 |
| Medicare PECOS PAC ID | 3476606252 |
|---|---|
| Medicare Enrollment ID | O20240621000910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376271981 | NPI | - | NPPES |
| Provider Name | Charles Roberts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225199912 PECOS PAC ID: 5395898076 Enrollment ID: I20240621001236 |
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