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General NPI Number Information
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NPI Number | 1306583083
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Entity Type | Organization
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Legal Business Name | MY MENTAL HEALTH SOLUTIONS
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 801 INTERNATIONAL PARKWAY FIFTH FLOOR
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City | LAKE MARY
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State | FL
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Zip | 32746-4762
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Country | US
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Telephone | 786-393-0315
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Fax |
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Provider Business Mailing Address
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Address Line | 3083 NEVERLAND DR
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City | NEW SMYRNA
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State | FL
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Zip | 32168-2442
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Country | US
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Telephone | 786-393-0315
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Fax |
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Authorized Official
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Title or Position | CLINICAL ADMINISTRATOR/OWNER
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Name | ANGELA MARIA HANSEN
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Credential | LCSW
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Telephone | 786-393-0315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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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