=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831413483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING LIVES THERAPEUTIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2010
-----------------------------------------------------
Last Update Date | 04/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 S SEMORAN BLVD SUITE 1093
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32792-5523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-721-0792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16877 E COLONIAL DR #191
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32820-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-721-0792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BEHAVIORAL HEALTH MANAGER
-----------------------------------------------------
Name | MS. LILLIAN ARBELO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 407-721-0792
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | SW9060
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------