Organization
A MINDFUL SPACE PSYCHOTHERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERROD JOHNSON (CEO)
(954) 574-2013
Entity
Organization
Contact information
Practice address
1400 NW 41ST CT, OAKLAND PARK, FL 33309-4520
(954) 574-2013
Mailing address
1400 NW 41ST CT, OAKLAND PARK, FL 33309-4520
(954) 574-2013
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
11/13/2024
Last updated
11/13/2024
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