Provider Demographics
NPI:1801064894
Name:THE WINTER PARK CENTER FOR PSYCHIATRY AND WELLNESS LLC
Entity type:Organization
Organization Name:THE WINTER PARK CENTER FOR PSYCHIATRY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-644-2121
Mailing Address - Street 1:1555 HOWELL BRANCH RD.
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1171
Mailing Address - Country:US
Mailing Address - Phone:407-644-2121
Mailing Address - Fax:407-644-2974
Practice Address - Street 1:1555 HOWELL BRANCH RD.
Practice Address - Street 2:SUITE B-4
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1171
Practice Address - Country:US
Practice Address - Phone:407-644-2121
Practice Address - Fax:407-644-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000109809102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty