Provider Demographics
NPI:1003360199
Name:EPIC BEHAVIORAL SOLUTIONS
Entity Type:Organization
Organization Name:EPIC BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:352-325-3603
Mailing Address - Street 1:1060 W HIGHWAY 50 STE 212
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2835
Mailing Address - Country:US
Mailing Address - Phone:352-321-7331
Mailing Address - Fax:
Practice Address - Street 1:1060 W HIGHWAY 50 STE 212
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2835
Practice Address - Country:US
Practice Address - Phone:352-325-3603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW95111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty