Healthcare Provider Details

I. General information

NPI: 1235570284
Provider Name (Legal Business Name): ALLIANCE MENTAL HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2013
Last Update Date: 07/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15120 COUNTY LINE RD
SPRING HILL FL
34610-6725
US

IV. Provider business mailing address

13404 WHITE PLAINS ST
SPRING HILL FL
34609-6472
US

V. Phone/Fax

Practice location:
  • Phone: 727-480-7504
  • Fax: 727-755-0315
Mailing address:
  • Phone: 727-480-7504
  • Fax: 727-755-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMH11264
License Number StateFL

VIII. Authorized Official

Name: MS. NANCY AVALONE
Title or Position: CEO
Credential: LMHC
Phone: 727-480-7504