Healthcare Provider Details

I. General information

NPI: 1043583867
Provider Name (Legal Business Name): COMPREHENSIVE PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 METROWEST BLVD 103
ORLANDO FL
32835-3289
US

IV. Provider business mailing address

6150 METROWEST BLVD 103
ORLANDO FL
32835-3289
US

V. Phone/Fax

Practice location:
  • Phone: 407-462-6701
  • Fax:
Mailing address:
  • Phone: 407-462-6701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7827
License Number StateFL

VIII. Authorized Official

Name: STEPHEN RYAN
Title or Position: CLINICAL DIRECTOR
Credential: LMHC
Phone: 407-462-6701