A MINDFUL SPACE PSYCHOTHERAPY, LLC
NPI 1851115158
Psychologist - Clinical in Oakland Park, FL

Q: What is A Mindful Space Psychotherapy, LLC's NPI number?

The NPI number for A Mindful Space Psychotherapy, LLC is 1851115158. It was assigned to this organization in the NPPES registry on November 13, 2024.

Q: What is A Mindful Space Psychotherapy, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Active since November 13, 2024

1400 NW 41ST CT, OAKLAND PARK, FL 33309(954) 574-2013 Get Directions Write a Review

NPPES record last updated: November 13, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About A Mindful Space Psychotherapy, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

A MINDFUL SPACE PSYCHOTHERAPY, LLC (NPI 1851115158) is a healthcare organization registered as a clinical in Oakland Park, Florida and active in the NPI registry since November 2024. The organization lists Jerrod Johnson, Ceo, as its authorized official.

NPPES Registry Identity

NPI1851115158

Entity TypeOrganization

Primary Taxonomy103TC0700X

Legal Business NameA MINDFUL SPACE PSYCHOTHERAPY, LLC

Location Address1400 NW 41ST CTOakland Park, FL 33309-4520

Mailing Address1400 Nw 41st CtOakland Park, FL 33309-4520 · (954) 574-2013

Phone(954) 574-2013

Organization SubpartNo

Authorized OfficialJerrod JohnsonCeo · (954) 574-2013

Enumeration DateNovember 13, 2024

NPPES CertifiedNovember 13, 2024

✔ NPI 1851115158 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

1400 NW 41ST CT, Oakland Park, FL 33309

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

A Mindful Space Psychotherapy, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to A Mindful Space Psychotherapy, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jerrod Johnson, PSY.D.

Clinical Psychologist

NPI 1780928556

4851 W HILLSBORO BLVD SUITE A1
Coconut Creek, FL 33073

(954) 428-6020

✔ PECOS✔ Accepts Medicare9.8 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is A Mindful Space Psychotherapy, LLC's NPI number?

The NPI number for A Mindful Space Psychotherapy, LLC is 1851115158. It was assigned to this organization in the NPPES registry on November 13, 2024.

Where is A Mindful Space Psychotherapy, LLC located?

A Mindful Space Psychotherapy, LLC is located at 1400 NW 41st Ct, Oakland Park, FL 33309. The listed phone number is (954) 574-2013.

What is A Mindful Space Psychotherapy, LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is A Mindful Space Psychotherapy, LLC enrolled in Medicare?

Yes. A Mindful Space Psychotherapy, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through A Mindful Space Psychotherapy, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to A Mindful Space Psychotherapy, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for A Mindful Space Psychotherapy, LLC was last updated on November 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.