Provider Demographics
NPI:1831070051
Name:LEAP FORWARD MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:LEAP FORWARD MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:I
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-306-8778
Mailing Address - Street 1:7742 N KENDALL DR STE 275
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7523
Mailing Address - Country:US
Mailing Address - Phone:786-306-8778
Mailing Address - Fax:
Practice Address - Street 1:8331 SW 100TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2417
Practice Address - Country:US
Practice Address - Phone:786-306-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)