Provider Demographics
NPI:1336704154
Name:BEHAVIORAL HEALTH MINUTE CLINIC LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH MINUTE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-702-9216
Mailing Address - Street 1:466 WOLDUNN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5914
Mailing Address - Country:US
Mailing Address - Phone:561-702-9216
Mailing Address - Fax:321-363-1912
Practice Address - Street 1:1971 LEE RD STE 203
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1875
Practice Address - Country:US
Practice Address - Phone:407-450-8151
Practice Address - Fax:321-363-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty