Healthcare Provider Details

I. General information

NPI: 1649375650
Provider Name (Legal Business Name): LDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 SATELLITE BLVD STE D
ORLANDO FL
32837-8479
US

IV. Provider business mailing address

10502 SATELLITE BLVD STE D
ORLANDO FL
32837-8479
US

V. Phone/Fax

Practice location:
  • Phone: 407-850-9141
  • Fax: 407-850-9687
Mailing address:
  • Phone: 407-850-9141
  • Fax: 407-850-9687

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: ADAM BARNES
Title or Position: AGENCY DIRECTOR
Credential: PMH
Phone: 407-850-9141