1366338535 NPI number — THE MIND GYM, INC.

Table of content: (NPI 1366338535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366338535 NPI number — THE MIND GYM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MIND GYM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366338535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3111 NW 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33125-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-592-0057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11367 SW 248TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33032-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-879-5355
Provider Business Practice Location Address Fax Number:
786-879-5355
Provider Enumeration Date:
06/16/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MALDONADO
Authorized Official First Name:
MILAGROS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
786-879-5355

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 583373574 . This is a "MENTAL HEALTH COUNSELOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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