Healthcare Provider Details

I. General information

NPI: 1790249696
Provider Name (Legal Business Name): THE BE CENTRE FOR MENTAL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10312 BLOOMINGDALE AVE STE 108-172
RIVERVIEW FL
33578-3663
US

IV. Provider business mailing address

10312 BLOOMINGDALE AVE STE 108-172
RIVERVIEW FL
33578-3663
US

V. Phone/Fax

Practice location:
  • Phone: 813-603-7473
  • Fax:
Mailing address:
  • Phone: 813-603-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JERMIA M SMITH
Title or Position: OWNER/CEO
Credential: LMHC
Phone: 813-603-7473