| Mandala Family Wellness Llc | |
|
171 Canal Blvd Ponte Vedra Beach FL 32082-3607 | |
| (904) 608-0782 | |
| Not Available |
| Full Name | Mandala Family Wellness Llc |
|---|---|
| Speciality | Psychologist |
| Location | 171 Canal Blvd, Ponte Vedra Beach, Florida |
| Authorized Official Name and Position | Katherine Falwell (CEO) |
| Authorized Official Contact | 9045216266 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mandala Family Wellness Llc 171 Canal Blvd Ponte Vedra Beach FL 32082-3607 Ph: () - | Mandala Family Wellness Llc 171 Canal Blvd Ponte Vedra Beach FL 32082-3607 Ph: (904) 608-0782 |
| NPI Number | 1497262620 |
|---|---|
| Provider Enumeration Date | 01/09/2018 |
| Last Update Date | 10/05/2023 |
| Certification Date | 08/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497262620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY7735 (Florida) | Primary |
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