Provider Demographics
NPI:1427819762
Name:MIND AND WELLNESS HEALTHCARE SERVICES
Entity type:Organization
Organization Name:MIND AND WELLNESS HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:MANOUCHKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILDOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:561-258-4867
Mailing Address - Street 1:11223 46TH PL N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9137
Mailing Address - Country:US
Mailing Address - Phone:156-185-6428
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD STE 209-8
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3275
Practice Address - Country:US
Practice Address - Phone:561-856-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty