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General NPI Number Information
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NPI Number | 1285876409
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Entity Type | Individual
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Provider Name | MANUEL O. GOMEZ MS., LMH,MCAP, CCM,
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Gender | Male
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 141 E CENTRAL AVE STE 340
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City | WINTER HAVEN
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State | FL
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Zip | 33880
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Country | US
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Telephone | 863-412-8711
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Fax | 877-340-0107
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Provider Business Mailing Address
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Address Line | 141 E CENTRAL AVE STE 340
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City | WINTER HAVEN
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State | FL
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Zip | 33880-6339
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Country | US
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Telephone | 863-412-8711
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Fax | 877-340-0107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ABC010814-215
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6158
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 131096
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 689259179
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11142
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License Number State | FL
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