Provider Demographics
NPI:1023725520
Name:UNCLOUDED MIND BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:UNCLOUDED MIND BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUNDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUILLAUME-SPONSEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-902-4952
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-0958
Mailing Address - Country:US
Mailing Address - Phone:727-902-4952
Mailing Address - Fax:
Practice Address - Street 1:850 E LIME ST
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4702
Practice Address - Country:US
Practice Address - Phone:727-902-4952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center