Healthcare Provider Details

I. General information

NPI: 1053510883
Provider Name (Legal Business Name): BELTRAN BEHAVIORAL HEALTH,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 HILLSDALE LN
KISSIMMEE FL
34741-7562
US

IV. Provider business mailing address

3214 HILLSDALE LN
KISSIMMEE FL
34741-7562
US

V. Phone/Fax

Practice location:
  • Phone: 407-518-9161
  • Fax: 407-518-9942
Mailing address:
  • Phone: 407-518-9161
  • Fax: 407-518-9942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7102
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH 8768
License Number StateFL

VIII. Authorized Official

Name: MRS. ANGELA M BELTRAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-518-9161