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General NPI Number Information
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NPI Number | 1003215013
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Entity Type | Organization
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Legal Business Name | MORNING LIGHT WELLNESS CENTERS, LLC
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 08/14/2014
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Provider Practice Location Address
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Address Line | 4601 34TH ST S SUITE 126
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City | SAINT PETERSBURG
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State | FL
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Zip | 33711-4552
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Country | US
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Telephone | 727-425-7526
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 34TH ST S SUITE 126
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City | SAINT PETERSBURG
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State | FL
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Zip | 33711-4552
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Country | US
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Telephone | 727-425-7526
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. RICH MILLS
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Credential | MS, LMHC, QS
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Telephone | 727-425-7526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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