Mangrove Wellness Center,inc

NPI #1285987453 in Venice, Florida

Provider Information

NPI Number: 1285987453
Entity Type: Organization
Organization Name: Mangrove Wellness Center,inc
Primary Specialty: Counselor - Mental Health
Enumeration Date: Oct 24, 2012
Last Updated: Oct 13, 2014

Practice Location

Address: 1515 TAMIAMI TRAIL S.
Address 2: SUITE 2
City: Venice
State: Florida
ZIP Code: 34285
Phone: (941) 822-5620

Authorized Official

Name: LISA REIDSEMA, LMHC
Title: PRESIDENT
Phone: (941) 822-5620

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Professional — Professional	101YP2500X
Psychologist - Clinical — Clinical	103TC0700X
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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