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General NPI Number Information
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NPI Number | 1770916652
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Entity Type | Organization
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Legal Business Name | MY WHOLE HEALTH LIFE, LLC
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 6965 PIAZZA GRANDE AVE
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City | ORLANDO
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State | FL
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Zip | 32835-8779
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Country | US
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Telephone | 407-203-5090
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Fax | 407-203-5092
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Provider Business Mailing Address
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Address Line | 6965 PIAZZA GRANDE AVE
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City | ORLANDO
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State | FL
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Zip | 32835-8779
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Country | US
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Telephone | 407-203-5090
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Fax | 407-203-5092
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Authorized Official
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Title or Position | COUNSELOR
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Name | DR. CLEYDE SENA SILVA
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Credential | PHD
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Telephone | 407-203-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CMHP 50094
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCCC 052784
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License Number State | FL
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