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General NPI Number Information
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NPI Number | 1831837616
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Entity Type | Organization
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Legal Business Name | CAMPBELL'S MULTI SERVICE OUTREACH CENTER
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 211 DORIS DR
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City | LAKELAND
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State | FL
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Zip | 33813-1006
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Country | US
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Telephone | 863-860-4516
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Fax | 863-837-4413
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Provider Business Mailing Address
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Address Line | 715 HEMENWAY DR NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-2700
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Country | US
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Telephone | 863-860-4516
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LATANGRA MCINTOSH MCINTOSH
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Credential | PMHNP
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Telephone | 863-860-4516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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