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General NPI Number Information
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NPI Number | 1508375742
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Entity Type | Organization
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Legal Business Name | HORIZON WEST NEUROBEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 13790 BRIDGEWATER CROSSINGS BLVD 1080
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City | WINDERMERE
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State | FL
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Zip | 34786-5446
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Country | US
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Telephone | 407-461-0239
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Fax |
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Provider Business Mailing Address
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Address Line | 13790 BRIDGEWATER CROSSINGS BLVD #1080
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City | WINDERMERE
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State | FL
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Zip | 34786-5447
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Country | US
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Telephone | 407-461-0239
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. NICOLE M WHITT
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Credential | PSY.D.
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Telephone | 407-906-1037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | PY9639
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License Number State | FL
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