Healthcare Provider Details

I. General information

NPI: 1508375742
Provider Name (Legal Business Name): HORIZON WEST NEUROBEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13790 BRIDGEWATER CROSSINGS BLVD 1080
WINDERMERE FL
34786-5446
US

IV. Provider business mailing address

13790 BRIDGEWATER CROSSINGS BLVD #1080
WINDERMERE FL
34786-5447
US

V. Phone/Fax

Practice location:
  • Phone: 407-461-0239
  • Fax:
Mailing address:
  • Phone: 407-461-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY9639
License Number StateFL

VIII. Authorized Official

Name: DR. NICOLE M WHITT
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 407-906-1037