Healthcare Provider Details

I. General information

NPI: 1245020080
Provider Name (Legal Business Name): MY COPING LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4071 L B MCLEOD RD
ORLANDO FL
32811-5662
US

IV. Provider business mailing address

4071 L B MCLEOD RD
ORLANDO FL
32811-5662
US

V. Phone/Fax

Practice location:
  • Phone: 407-712-6394
  • Fax:
Mailing address:
  • Phone: 407-712-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: IMARI MELTON
Title or Position: PRESIDENT
Credential:
Phone: 407-712-6394