Provider Demographics
NPI:1134332083
Name:SEMINOLE COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SEMINOLE COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TURNING POINT PROGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:PITKETHLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MASTER OF ARTS
Authorized Official - Phone:407-323-4445
Mailing Address - Street 1:4258 CLOVERLEAF PL
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-4703
Mailing Address - Country:US
Mailing Address - Phone:407-696-7102
Mailing Address - Fax:
Practice Address - Street 1:300 S BAY AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2141
Practice Address - Country:US
Practice Address - Phone:407-323-4445
Practice Address - Fax:407-732-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services