Provider Demographics
NPI:1235570284
Name:ALLIANCE MENTAL HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:ALLIANCE MENTAL HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVALONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-480-7504
Mailing Address - Street 1:13404 WHITE PLAINS ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-6472
Mailing Address - Country:US
Mailing Address - Phone:727-480-7504
Mailing Address - Fax:727-755-0315
Practice Address - Street 1:15120 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6725
Practice Address - Country:US
Practice Address - Phone:727-480-7504
Practice Address - Fax:727-755-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty