The Imind Foundation

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THE IMIND FOUNDATION

Practice address

145 NW Central Park PLZ Ste 112
Port Saint Lucie, FL 34986-2482

Phone

(772) 617-6373

Fax

(844) 440-1724

NPI assigned

Jun 1, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Kalel Baksh, LMHC, MCAPNPI 1447618590

Title

Ceo

Phone

(772) 617-6373

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Kalel Baksh, MS, LMHC, MCAP, QS,

  • Mental Health Counselor
  • Port St Lucie, FL
  • NPI 1447618590
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717200000000",
    "number": "1255172631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 NW CENTRAL PARK PLZ STE 104",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349861825",
            "telephone_number": "772-617-6373",
            "fax_number": "844-440-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 NW CENTRAL PARK PLZ STE 112",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349862482",
            "telephone_number": "772-617-6373",
            "fax_number": "844-440-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE IMIND FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-01",
        "last_updated": "2024-06-01",
        "certification_date": "2024-06-01",
        "status": "A",
        "authorized_official_last_name": "BAKSH",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "KALEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "772-617-6373",
        "authorized_official_credential": "LMHC, MCAP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.