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General NPI Number Information
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NPI Number | 1417725185
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Entity Type | Organization
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Legal Business Name | CENTERED MIND HEALTH LLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2054 CLASSIQUE LN
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City | TAVARES
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State | FL
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Zip | 32778-5787
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Country | US
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Telephone | 407-913-4974
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Fax |
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Provider Business Mailing Address
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Address Line | 4630 S KIRKMAN RD STE 111
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City | ORLANDO
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State | FL
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Zip | 32811-2833
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Country | US
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Telephone | 407-913-4974
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUSAN WAMBUI GRAY
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Credential | RN, APRN, PMHNP-BC
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Telephone | 770-912-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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