MEDICARE: REDEEMED MENTAL HEALTH WELLNESS CENTER, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700618816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDEEMED MENTAL HEALTH WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	6249 EDGEWATER DR # 1128
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4739
Country	:	US
Telephone Number	:	407-734-0824
Fax Number	:

Provider Business Practice Location Address
First Line	:	6249 EDGEWATER DR # 1128
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-4739
Country	:	US
Telephone Number	:	407-734-0824
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KIARA GANT
Credential	:	LMHC
Telephone Number	:	407-734-0824

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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