Provider Demographics
NPI:1487140315
Name:REAL PEOPLE THERAPY LLC
Entity type:Organization
Organization Name:REAL PEOPLE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SECRAN MANSILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-334-4748
Mailing Address - Street 1:5201 MILL STREAM RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-8121
Mailing Address - Country:US
Mailing Address - Phone:407-334-4748
Mailing Address - Fax:
Practice Address - Street 1:7350 FUTURES DR STE 18
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9084
Practice Address - Country:US
Practice Address - Phone:407-334-4748
Practice Address - Fax:321-236-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 251S00000X, 261QM0855X, 261QM0850X
FLSW119681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598177727OtherINDIVIDUAL NPI