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General NPI Number Information
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NPI Number | 1679190078
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MULTIDISCIPLINARY CENTER CORP
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1416 SIMPSON RD
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City | KISSIMMEE
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State | FL
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Zip | 34744-4600
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Country | US
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Telephone | 321-947-8923
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Fax | 407-307-2328
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Provider Business Mailing Address
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Address Line | 2840 WILLOWSEED LN
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City | SAINT CLOUD
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State | FL
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Zip | 34772-9364
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Country | US
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Telephone | 321-947-9220
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Fax | 407-307-2328
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MARIELY COLON
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Credential | PH.D, LMHC, MBA
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Telephone | 407-541-7965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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