Healthcare Provider Details

I. General information

NPI: 1649913831
Provider Name (Legal Business Name): BALANCED MIND BEHAVIORAL SERVICES, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13139 LAVER LN
ORLANDO FL
32824-7560
US

IV. Provider business mailing address

13139 LAVER LN
ORLANDO FL
32824-7560
US

V. Phone/Fax

Practice location:
  • Phone: 787-810-9765
  • Fax: 407-307-2328
Mailing address:
  • Phone: 787-810-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: VERONICA GONZALEZ
Title or Position: CEO
Credential: MA
Phone: 787-810-9765