Azul Mindspace LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

AZUL MINDSPACE LLC

Practice address

10631 Habitat TRL
Bokeelia, FL 33922-3122

Phone

(786) 505-4022

NPI assigned

Oct 18, 2023

Last updated

Oct 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michelle Renee White, MA

Title

Psychologist / Owner

Phone

(786) 505-4022

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697673600000",
    "number": "1508648072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10631 HABITAT TRL",
            "city": "BOKEELIA",
            "state": "FL",
            "postal_code": "339223122",
            "telephone_number": "786-505-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10631 HABITAT TRL",
            "city": "BOKEELIA",
            "state": "FL",
            "postal_code": "339223122",
            "telephone_number": "786-505-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZUL MINDSPACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PSYCHOLOGIST / OWNER",
        "authorized_official_telephone_number": "786-505-4022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.