Healthcare Provider Details

I. General information

NPI: 1265796361
Provider Name (Legal Business Name): HORIZONS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8849 HAWBUCK ST
TRINITY FL
34655-5361
US

IV. Provider business mailing address

8849 HAWBUCK ST
TRINITY FL
34655-5361
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-3652
  • Fax: 727-376-3652
Mailing address:
  • Phone: 727-376-3652
  • Fax: 727-376-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberME96486
License Number StateFL

VIII. Authorized Official

Name: DR. SYED HASAN WAQAR
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 352-540-9335