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Organization
MANGROVE WELLNESS CENTER,INC
Active
Organization
MANGROVE WELLNESS CENTER,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA REIDSEMA LMHC (PRESIDENT)
(941) 822-5620
Entity
Organization
Contact information
Practice address
1515 TAMIAMI TRAIL S., SUITE 2, VENICE, FL 34285
(941) 822-5620
(855) 239-0365
Mailing address
1515 TAMIAMI TRAIL S., SUITE 2, VENICE, FL 34285
(941) 822-5620
(855) 239-0365
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH12785
FL
101YP2500X
Professional Counselor
MH12785
FL
101YP2500X
Professional Counselor
PY5867
FL
103TC0700X
Clinical Psychologist
PY5867
FL
Other
Enumeration date
10/24/2012
Last updated
10/13/2014
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