Healthcare Provider Details

I. General information

NPI: 1083946297
Provider Name (Legal Business Name): INTERVENTION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SPARTAN DR
MAITLAND FL
32751-3468
US

IV. Provider business mailing address

150 SPARTAN DR
MAITLAND FL
32751-3468
US

V. Phone/Fax

Practice location:
  • Phone: 407-331-8002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BECKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-331-8002