Healthcare Provider Details

I. General information

NPI: 1528389590
Provider Name (Legal Business Name): CHILDREN AND FAMILY PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 S ORANGE BLOSSOM TRL STE 161
ORLANDO FL
32809-4677
US

IV. Provider business mailing address

6220 S ORANGE BLOSSOM TRL STE 161
ORLANDO FL
32809-4677
US

V. Phone/Fax

Practice location:
  • Phone: 407-697-9247
  • Fax:
Mailing address:
  • Phone: 407-697-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY HAROLD BLOUNT
Title or Position: CEO
Credential: BCBA, LMHC
Phone: 407-697-9247