Healthcare Provider Details

I. General information

NPI: 1245834373
Provider Name (Legal Business Name): KACEE MINEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 WILLISTON PARK PT
LAKE MARY FL
32746-2164
US

IV. Provider business mailing address

6900 TAVISTOCK LAKES BLVD STE 400
ORLANDO FL
32827-7593
US

V. Phone/Fax

Practice location:
  • Phone: 407-710-8566
  • Fax:
Mailing address:
  • Phone: 800-875-1871
  • Fax: 800-875-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: