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General NPI Number Information
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NPI Number | 1770528846
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Entity Type | Organization
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Legal Business Name | INDIALANTIC PSYCHIATRY & COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 345 6TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-4301
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Country | US
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Telephone | 321-951-2100
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Fax | 321-951-1204
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Provider Business Mailing Address
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Address Line | 345 6TH AVE
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City | INDIALANTIC
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State | FL
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Zip | 32903-4301
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Country | US
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Telephone | 321-951-2100
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Fax | 321-951-1204
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINEET MEHTA
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Credential | M.D.
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Telephone | 321-951-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | ME0054791
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License Number State | FL
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