Provider Demographics
NPI:1306690722
Name:MINDZEN LLC
Entity type:Organization
Organization Name:MINDZEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PROIVDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRABHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:813-575-0477
Mailing Address - Street 1:21814 WAVERLY SHORES LN
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7562
Mailing Address - Country:US
Mailing Address - Phone:813-575-0477
Mailing Address - Fax:
Practice Address - Street 1:322 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1228
Practice Address - Country:US
Practice Address - Phone:813-575-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty