=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568601003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE MENTAL HEALTH GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2009
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27-642 CASHFORD CIRCLE SUITE 106
-----------------------------------------------------
City | WESLEY CHAPEL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-992-1965
-----------------------------------------------------
Fax | 813-388-4442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1621 E. 4TH AVENUE SUITE 206
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-992-1965
-----------------------------------------------------
Fax | 813-388-4442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | ARTHUR H BELMONT
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 813-992-1965
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2233
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------