Provider Demographics
NPI:1013374842
Name:COLLAZO MONTES, BEBALINEZ
Entity Type:Individual
Prefix:
First Name:BEBALINEZ
Middle Name:
Last Name:COLLAZO MONTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 JACK BRACK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9235
Mailing Address - Country:US
Mailing Address - Phone:407-962-9838
Mailing Address - Fax:
Practice Address - Street 1:5725 JACK BRACK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9235
Practice Address - Country:US
Practice Address - Phone:407-301-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty