Provider Demographics
NPI:1194566547
Name:MINGO, BRITNAE T
Entity type:Individual
Prefix:
First Name:BRITNAE
Middle Name:T
Last Name:MINGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 BEECHWOOD CIR S
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-6766
Mailing Address - Country:US
Mailing Address - Phone:786-728-6747
Mailing Address - Fax:
Practice Address - Street 1:1727 BEECHWOOD CIR S
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-6766
Practice Address - Country:US
Practice Address - Phone:786-728-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health