Healthcare Provider Details

I. General information

NPI: 1972659746
Provider Name (Legal Business Name): CHARLES R. BELL III ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S JOHN YOUNG PKWY
ORLANDO FL
32805-6639
US

IV. Provider business mailing address

3000 S JOHN YOUNG PKWY
ORLANDO FL
32805-6639
US

V. Phone/Fax

Practice location:
  • Phone: 407-514-4470
  • Fax: 407-514-4509
Mailing address:
  • Phone: 407-514-4470
  • Fax: 407-514-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 2044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: