Healthcare Provider Details

I. General information

NPI: 1285198135
Provider Name (Legal Business Name): NEIGHBORHOOD TIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PARK CENTER DR
ORLANDO FL
32835-6235
US

IV. Provider business mailing address

1701 PARK CENTER DR
ORLANDO FL
32835-6235
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3837
  • Fax: 407-730-3869
Mailing address:
  • Phone: 407-730-3837
  • Fax: 407-730-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN RYAN
Title or Position: CLINICAL DIRECTOR
Credential: LMHC
Phone: 407-730-3837