Healthcare Provider Details

I. General information

NPI: 1245698463
Provider Name (Legal Business Name): FHL PSYCHIATRIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 S US HIGHWAY 441 UNIT 300
SUMMERFIELD FL
34491-4482
US

IV. Provider business mailing address

2675 CEDAR CREST DR
APOPKA FL
32712-5019
US

V. Phone/Fax

Practice location:
  • Phone: 407-280-4890
  • Fax: 888-567-3781
Mailing address:
  • Phone: 407-280-4890
  • Fax: 888-567-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberME118567
License Number StateFL

VIII. Authorized Official

Name: CARLES SICARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 410-322-4575