Healthcare Provider Details

I. General information

NPI: 1356220677
Provider Name (Legal Business Name): DEPRESSION AND MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 US HIGHWAY 27 S
AVON PARK FL
33825-9755
US

IV. Provider business mailing address

5063 MOSS HAMMOCK TRL
SEBRING FL
33872-4404
US

V. Phone/Fax

Practice location:
  • Phone: 863-358-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ORLAND MATA CRUZ
Title or Position: MANAGER
Credential: APRN
Phone: 863-840-0639