Provider Demographics
NPI:1003643867
Name:MINDFUL THOUGHTS PSYCHIATRY WALKIN CLINIC
Entity type:Organization
Organization Name:MINDFUL THOUGHTS PSYCHIATRY WALKIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:828-390-8255
Mailing Address - Street 1:8833 OLD SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-9074
Mailing Address - Country:US
Mailing Address - Phone:828-390-8255
Mailing Address - Fax:
Practice Address - Street 1:8833 OLD SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-9074
Practice Address - Country:US
Practice Address - Phone:828-390-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty