Healthcare Provider Details

I. General information

NPI: 1780507400
Provider Name (Legal Business Name): CHOSEN THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 PINE LAKE RD
ORLANDO FL
32808-6323
US

IV. Provider business mailing address

1422 PINE LAKE RD
ORLANDO FL
32808-6323
US

V. Phone/Fax

Practice location:
  • Phone: 912-963-7256
  • Fax:
Mailing address:
  • Phone: 912-963-7256
  • Fax: 689-256-5356

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENETRESS MONTOYA HINTON
Title or Position: OWNER
Credential: PHD
Phone: 912-963-7256