Provider Demographics
NPI:1902939820
Name:CENTRAL FLORIDA MENTAL HEALTH
Entity Type:Organization
Organization Name:CENTRAL FLORIDA MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-536-2364
Mailing Address - Street 1:221 N HIGHWAY 27
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2431
Mailing Address - Country:US
Mailing Address - Phone:352-536-2364
Mailing Address - Fax:352-536-2370
Practice Address - Street 1:221 N HIGHWAY 27
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2431
Practice Address - Country:US
Practice Address - Phone:352-536-2364
Practice Address - Fax:352-536-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72149600OtherMAGELLAN
FLHARMONYOther276309
FL535703OtherVALUE OPTIONS
FL0007392583OtherAETNA
FL1197964OtherCIGNA
FLZ080UOtherBLUE CROSS BLUE SHIELD
FL3290746OtherUNITED BEHAVIORAL HEALTH