NPIMap

Organization Active NPI

Mindful Behavioral Healthcare, LLC

  • Community/Behavioral Health Agency
  • Kissimmee, FL
National Provider Identifier
1477744548
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MINDFUL BEHAVIORAL HEALTHCARE, LLC
Practice address
717 E Oak St
Kissimmee, FL 34744-4580
Phone
(407) 846-0533
Fax
(407) 518-1730
NPI assigned
Aug 5, 2007
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

717 E Oak St
Kissimmee, FL 34744-4580

Mailing address

719 East Oak Street
Kissimmee, FL 34744
Phone (407) 846-0533

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111205000619 FL Part B Supplier - Clinic/Group Practice 7810162740 Receives reassigned benefits from 24 practitioners
Practice locations: Kissimmee, FL

National Provider Directory

National Provider Directory

Locations

301 N Highway 27
Unit C
Clermont, FL 34711
Phone (407) 286-9103

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

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1477744548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 EAST OAK STREET",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34744",
            "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": "717 E OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347444580",
            "telephone_number": "407-846-0533",
            "fax_number": "407-518-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL BEHAVIORAL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2022-01-26",
        "certification_date": "2021-09-27",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.