NPIMap

Organization Active NPI

Mindful Behavioral Healthcare, LLC

  • Psychiatry Physician
  • Orlando, FL
National Provider Identifier
1447920616
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MINDFUL BEHAVIORAL HEALTHCARE, LLC
Practice address
10920 Moss Park Rd Ste 200
Orlando, FL 32832-6087
Phone
(407) 846-0533
Fax
(407) 518-1730
NPI assigned
Sep 17, 2021
Last updated
Jan 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Authorized official

Name
Michelle Missigman
Title
Coo
Phone
(352) 328-9139

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

10920 Moss Park Rd Ste 200
Orlando, FL 32832-6087

Mailing address

717 E Oak St
Kissimmee, FL 34744-4580
Phone (407) 846-0533

Other identifiers 1

IdentifierTypeStateIssuer
006520801MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Mindful Behavioral Healthcare LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22714/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1447920616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 E OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444580",
            "telephone_number": "407-846-0533",
            "fax_number": "407-518-1730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10920 MOSS PARK RD STE 200",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328326087",
            "telephone_number": "407-846-0533",
            "fax_number": "407-518-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIORAL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "MISSIGMAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "352-328-9139"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006520801",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.