MEDICARE: MELTING WALLS FAMILY CONSULTANTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1982729570	OTHER	FL	PRACTICE OWNER

General Provider Information

NPI Number	:	1093298457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELTING WALLS FAMILY CONSULTANTS

Provider Business Mailing Address
First Line	:	1809 E BROADWAY ST STE 355
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-8597
Country	:	US
Telephone Number	:	407-953-2497
Fax Number	:	407-359-2756

Provider Business Practice Location Address
First Line	:	1100 TOWN PLAZA CT STE 1010
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6231
Country	:	US
Telephone Number	:	407-953-2497
Fax Number	:	407-359-2756

Authorized Official
Title or Position	:	BUSINESS OPERATIONS
Name	:	DR. KEVIN TURNER
Credential	:	PHD
Telephone Number	:	407-953-7927

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	09/12/2018

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