Healthcare Provider Details

I. General information

NPI: 1710727078
Provider Name (Legal Business Name): HALCYON PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 SW 116TH PL
OCALA FL
34476-4454
US

IV. Provider business mailing address

5261 SW 116TH PL
OCALA FL
34476-4454
US

V. Phone/Fax

Practice location:
  • Phone: 305-606-6749
  • Fax:
Mailing address:
  • Phone: 305-606-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LISSETTE CALDERON
Title or Position: OWNER
Credential:
Phone: 305-606-6749