Provider Demographics
NPI:1316495211
Name:MORMINDFUL THERAPY & PSYCHIATRY INC
Entity type:Organization
Organization Name:MORMINDFUL THERAPY & PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-253-0793
Mailing Address - Street 1:1 W CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5966
Mailing Address - Country:US
Mailing Address - Phone:954-253-0793
Mailing Address - Fax:
Practice Address - Street 1:1 W CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5966
Practice Address - Country:US
Practice Address - Phone:954-253-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty