=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295965234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY MENTAL HEALTH AND BEHAVIORAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2009
-----------------------------------------------------
Last Update Date | 07/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6021 WEDGEWOOD CIR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32808-5443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-297-7505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 585509
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32858-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 407-292-1804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER, REGISTERED AGENT
-----------------------------------------------------
Name | ROBIN WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-297-7505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MH8246
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 1-05-2284
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------