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General NPI Number Information
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NPI Number | 1336704154
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH MINUTE CLINIC LLC
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 1971 LEE RD STE 203
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City | WINTER PARK
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State | FL
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Zip | 32789-1875
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Country | US
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Telephone | 407-450-8151
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Fax | 321-363-1912
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Provider Business Mailing Address
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Address Line | 466 WOLDUNN CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-5914
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Country | US
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Telephone | 561-702-9216
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Fax | 321-363-1912
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Authorized Official
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Title or Position | OWNER
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Name | RENA PETERSON
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Credential | PSYD
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Telephone | 561-702-9216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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