Provider Demographics
NPI:1023844255
Name:MIND-FULLY-YOURS RECOVERY & WELLNESS
Entity type:Organization
Organization Name:MIND-FULLY-YOURS RECOVERY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:305-336-2162
Mailing Address - Street 1:977 SW COLLEGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5869
Mailing Address - Country:US
Mailing Address - Phone:305-336-2162
Mailing Address - Fax:
Practice Address - Street 1:977 SW COLLEGE PARK RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5869
Practice Address - Country:US
Practice Address - Phone:305-336-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty