Healthcare Provider Details

I. General information

NPI: 1366351686
Provider Name (Legal Business Name): MENTAL HEALTH ON DEMAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 N WOODLAND BLVD # 116-441
DELAND FL
32720-1837
US

IV. Provider business mailing address

1156 COWART RD
PIERSON FL
32180-2108
US

V. Phone/Fax

Practice location:
  • Phone: 386-747-9129
  • Fax:
Mailing address:
  • Phone: 386-295-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE POWELL
Title or Position: APRN/OWNER
Credential: APRN
Phone: 386-295-7995