Healthcare Provider Details

I. General information

NPI: 1417536145
Provider Name (Legal Business Name): PROVIDERS FOR HEALTHY LIVING II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N MAITLAND AVE STE 340
MAITLAND FL
32751-4761
US

IV. Provider business mailing address

341 N MAITLAND AVE STE 340
MAITLAND FL
32751-4761
US

V. Phone/Fax

Practice location:
  • Phone: 407-219-3281
  • Fax: 407-219-3281
Mailing address:
  • Phone: 407-219-3281
  • Fax: 614-664-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW LOWE
Title or Position: CEO
Credential: DO
Phone: 407-219-3281