Provider Demographics
NPI:1235754292
Name:COLLECTIVE MENTAL HEALTH
Entity Type:Organization
Organization Name:COLLECTIVE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:074-310-4485
Mailing Address - Street 1:3455 ASTORIA CT
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2005
Mailing Address - Country:US
Mailing Address - Phone:073-104-4854
Mailing Address - Fax:717-427-4153
Practice Address - Street 1:3455 ASTORIA CT
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2005
Practice Address - Country:US
Practice Address - Phone:321-241-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA