Update this page – If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS.
Organization
MINDFULLY, LLC
Active
Organization
MINDFULLY, LLC
Active
Parent organization
MINDFULLY, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MINDFULLY, LLC
Authorized official
CHARLES K ROBERTS EDD, LPCC-S, LICDC-C (AUTHORIZED OFFICIAL)
(888) 830-0347
Entity
Organization
Contact information
Practice address
10151 DEERWOOD PARK BLVD STE 250, JACKSONVILLE, FL 32256-0566
(888) 830-0347
(513) 939-0310
Mailing address
1251 NILLES RD STE 5, FAIRFIELD, OH 45014-7205
(888) 830-0347
(513) 939-0310
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
08/11/2022
Last updated
08/06/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up