NPIMap

Organization Active NPI

Mindful Health Services LLC

  • Clinical Neuropsychologist
  • Port St Lucie, FL
National Provider Identifier
1619510336
Registry record updated Oct 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
MINDFUL HEALTH SERVICES LLC
Doing business as
Mindful Health Services LLC
Practice address
160 NW Central Park PLZ Ste 105
Port St Lucie, FL 34986-1825
Phone
(772) 812-6852
Fax
(772) 494-7271
NPI assigned
Oct 25, 2019
Last updated
Oct 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2019

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

Authorized official

Name
Travis B Thame
Title
Owner
Phone
(772) 812-6852

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X Primary
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X

Addresses

Primary practice location

160 NW Central Park PLZ Ste 105
Port St Lucie, FL 34986-1825

Mailing address

160 NW Central Park PLZ Ste 105
Port St Lucie, FL 34986-1825
Phone (772) 812-6852

Other names 1

  • MINDFUL HEALTH SERVICES LLC Doing business as

National Provider Directory

National Provider Directory

Locations

160 NW Central Park Plz
Ste 105
Port St Lucie, FL 34986
Phone (772) 303-1987

NPI Registry JSON

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571961600000",
    "number": "1619510336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 NW CENTRAL PARK PLZ STE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861825",
            "telephone_number": "772-812-6852",
            "fax_number": "772-494-7271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 NW CENTRAL PARK PLZ STE 105",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861825",
            "telephone_number": "772-812-6852",
            "fax_number": "772-494-7271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-25",
        "last_updated": "2019-10-25",
        "status": "A",
        "authorized_official_last_name": "THAME",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-812-6852"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MINDFUL HEALTH SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; 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.