Mandala Counseling Services LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MANDALA COUNSELING SERVICES LLC

Practice address

6361 Presidential CT Ste 101
Fort Myers, FL 33919-3583

Phone

(239) 360-1976

NPI assigned

Oct 2, 2019

Last updated

Oct 28, 2022By 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

Brianna Kelly Jaworski, LMHCNPI 1932687167

Title

Owner

Phone

(941) 962-9661

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

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.

• Brianna Kelly Jaworski, LMHC

  • Mental Health Counselor
  • Fort Myers, FL
  • NPI 1932687167
  Medicare reassignment NPD Authorized official
• Stephanie Kerns, MA

  • Social Worker
  • Fort Myers, FL
  • NPI 1407323850

  Mental Health

  Medicare reassignment NPD
• Rosy Ramirez

  • Mental Health Counselor
  • Fort Myers, FL
  • NPI 1750222071
  NPD (past)

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1871134627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6361 PRESIDENTIAL CT STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193583",
            "telephone_number": "239-360-1983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6361 PRESIDENTIAL CT STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193583",
            "telephone_number": "239-360-1976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3403 Hancock Bridge Pkwy Ste 2",
            "address_purpose": "LOCATION",
            "city": "North Fort Myers",
            "state": "FL",
            "postal_code": "339037056",
            "country_code": "US",
            "telephone_number": "239-360-1983",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANDALA COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-02",
        "last_updated": "2022-10-28",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "JAWORSKI",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_middle_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-962-9661",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MENTAL HEALTH COUNSELOR",
            "identifier": "1932687167",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candice Roseann Maltezos, CRT
• Wendy Maltezos, LPN
• Timur Mamedov, M.D.
• Michael S. Mancano
• Kimberly Ann Mancl, MD
• Archana Reddy Mandala, M.D.
• Robert Marc Mandelkorn, M.D.
• George Timothy Mandybur, M.D.
• Elise N Manee, PHARMD
• Donna Joy Mangatt, O.D.

• Mental Health Counselor in Fort Myers, FL
• Providers in Fort Myers, 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 Oct 28, 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.