Center For Behavioral Medicine
Counselor, Mental Health in Port Orange, FL. Organization (NPI-2).
NPI number1003348855
StatusActive
Last updated in NPPESMar 31, 2017
Details
- NPI
- 1003348855
- Entity type
- Organization (NPI-2)
- Legal business name
- Center For Behavioral Medicine
- Organization subpart
- No
- Enumeration date
- Mar 31, 2017
- Last updated
- Mar 31, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | MH6409 | FL | Yes |
Practice location
1730 Dunlawton AveSuite 3
Port Orange, FL 32127-8985
Phone 138-695-7390
Mailing address
1730 Dunlawton AveSuite 3
Port Orange, FL 32127-8985
Authorized official
Shane Porter
Managing Partner
13869573905
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