MEDICARE: DIVERSIFIED BEHAVIORAL HEALTH SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MH4900	FL
2	251B00000X	Case Management Agency	MH4900	FL

General Provider Information

NPI Number	:	1376855155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED BEHAVIORAL HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	2404 MONTE CARLO TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3527
Country	:	US
Telephone Number	:	352-219-2276
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 MONTE CARLO TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3527
Country	:	US
Telephone Number	:	352-219-2276
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	MR. ANTHONY TU JUAN ADAMS
Credential	:	LMHC, NBCC
Telephone Number	:	352-219-2276

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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