Healthcare Provider Details

I. General information

NPI: 1669641015
Provider Name (Legal Business Name): THE ITM GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SW 7TH TER
GAINESVILLE FL
32601-6459
US

IV. Provider business mailing address

225 SW 7TH TER
GAINESVILLE FL
32601-6459
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-2829
  • Fax: 352-379-2843
Mailing address:
  • Phone: 352-379-2829
  • Fax: 352-379-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SINDY VELEZ
Title or Position: ITP COORDINATOR
Credential:
Phone: 352-379-2829