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General NPI Number Information
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NPI Number | 1972994812
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL SUPPORT SERVICES
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 2495 HURON CIR
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City | KISSIMMEE
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State | FL
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Zip | 34746-3443
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Country | US
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Telephone | 407-965-8013
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Fax |
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Provider Business Mailing Address
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Address Line | 2495 HURON CIR
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City | KISSIMMEE
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State | FL
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Zip | 34746-3443
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Country | US
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Telephone | 407-965-8013
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH TARGETED CASE MANAGER
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Name | JOSE ANIBAL BARRETO
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Credential | MED
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Telephone | 407-965-8013
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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 |
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License Number State | FL
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