Healthcare Provider Details

I. General information

NPI: 1568366193
Provider Name (Legal Business Name): POLARIS BEHAVIORAL & CONSULTING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 PARK POND WAY
KISSIMMEE FL
34741-7660
US

IV. Provider business mailing address

2990 PARK POND WAY
KISSIMMEE FL
34741-7660
US

V. Phone/Fax

Practice location:
  • Phone: 407-353-6595
  • Fax:
Mailing address:
  • Phone: 407-353-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILSON GIOVANNI VILLANUEVA
Title or Position: OWNER
Credential: LMHC
Phone: 407-353-6595