Organization
LAURIE MINTZ, PH.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIE MINTZ PH..D. (LICENSED PSYCHOLOGIST)
(573) 808-3828
Entity
Organization
Contact information
Practice address
2830 NW 41ST ST, SUITE D, GAINESVILLE, FL 32606-6667
(573) 808-3828
Mailing address
6304 SW 95TH ST, GAINESVILLE, FL 32608-5565
(573) 808-3828
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PY8648
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
599OU
FLORIDA BLUE PROVIDER NUMBER
FL
Enumeration date
03/09/2015
Last updated
03/09/2015
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