Healthcare Provider Details

I. General information

NPI: 1356933022
Provider Name (Legal Business Name): HM MENTAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12553 NEW BRITTANY BLVD STE 3211
FORT MYERS FL
33907-3625
US

IV. Provider business mailing address

12553 NEW BRITTANY BLVD STE 3211
FORT MYERS FL
33907-3625
US

V. Phone/Fax

Practice location:
  • Phone: 239-258-0775
  • Fax:
Mailing address:
  • Phone: 239-258-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUMBERTO MUNOZ
Title or Position: PRESIDENT
Credential:
Phone: 239-258-0775