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General NPI Number Information
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NPI Number | 1154631984
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Entity Type | Organization
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Legal Business Name | STRESS & ANXIETY CENTER
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 274 WILSHIRE BLVD SUITE 241
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City | CASSELBERRY
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State | FL
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Zip | 32707-5346
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Country | US
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Telephone | 307-830-4755
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Fax |
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Provider Business Mailing Address
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Address Line | 274 WILSHIRE BLVD SUITE 221
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City | CASSELBERRY
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State | FL
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Zip | 32707-5346
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Country | US
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Telephone | 307-830-4755
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. MILTON JR. COLLINS EL
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Credential | LCSW
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Telephone | 407-830-4755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3845
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License Number State | FL
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