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Organization
MINDESCAPE LLC
Active
Organization
MINDESCAPE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAVELYN MILLARD (DIRECTOR)
(800) 681-1403
Entity
Organization
Contact information
Practice address
27911 CROWN LAKE BLVD, BONITA SPRINGS, FL 34135-4210
(800) 961-3367
(800) 961-3367
Mailing address
27911 CROWN LAKE BLVD, BONITA SPRINGS, FL 34135-4210
(800) 861-1403
(800) 861-1403
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
103T00000X
Psychologist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
08/29/2024
Last updated
05/29/2026
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