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General NPI Number Information
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NPI Number | 1235754292
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Entity Type | Organization
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Legal Business Name | COLLECTIVE MENTAL HEALTH
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 3455 ASTORIA CT
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City | WINTER PARK
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State | FL
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Zip | 32792-2005
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Country | US
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Telephone | 321-241-2920
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Fax |
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Provider Business Mailing Address
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Address Line | 3455 ASTORIA CT
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City | WINTER PARK
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State | FL
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Zip | 32792-2005
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Country | US
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Telephone | 73-104-4854
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Fax | 717-427-4153
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Authorized Official
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Title or Position | OWNER
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Name | LISA Y LELLO
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Credential | LMHC
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Telephone | 74-310-4485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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