Healthcare Provider Details

I. General information

NPI: 1801680947
Provider Name (Legal Business Name): MENTAL OASIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 W PARK AVE UNIT 1363
LAKE WALES FL
33859-6257
US

IV. Provider business mailing address

6 W PARK AVE UNIT 1363
LAKE WALES FL
33859-6257
US

V. Phone/Fax

Practice location:
  • Phone: 352-593-3853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: L C. RIVERA
Title or Position: EMPLOYEE
Credential:
Phone: 352-593-3853