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General NPI Number Information
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NPI Number | 1548936941
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Entity Type | Organization
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Legal Business Name | PARADISE MENTAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 407 N HAMILTON ST
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City | DALTON
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State | GA
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Zip | 30720-3124
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Country | US
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Telephone | 786-774-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 407 N HAMILTON ST
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City | DALTON
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State | GA
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Zip | 30720-3124
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Country | US
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Telephone | 786-774-7135
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OSMANY GUTIERREZ
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Credential |
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Telephone | 786-774-7135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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