Provider Demographics
NPI:1346558327
Name:ORLANDO INTEGRATIVE MENTAL HEALTH PLC
Entity Type:Organization
Organization Name:ORLANDO INTEGRATIVE MENTAL HEALTH PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:CHANDRA
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-608-2576
Mailing Address - Street 1:1485 S SEMORAN BLVD BLDG 6
Mailing Address - Street 2:SUITE 1454
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:407-671-2258
Mailing Address - Fax:407-671-2675
Practice Address - Street 1:1485 S SEMORAN BLVD BLDG 6
Practice Address - Street 2:SUITE 1454
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5533
Practice Address - Country:US
Practice Address - Phone:407-671-2258
Practice Address - Fax:407-671-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1020762084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty