Provider Demographics
NPI:1417003310
Name:FLORIDA MENTOR
Entity Type:Organization
Organization Name:FLORIDA MENTOR
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIONDI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-624-2137
Mailing Address - Street 1:3200 SW 34TH AVE
Mailing Address - Street 2:BLDG. 200 SUITE 203
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7456
Mailing Address - Country:US
Mailing Address - Phone:352-624-2137
Mailing Address - Fax:352-624-2136
Practice Address - Street 1:3200 SW 34TH AVE
Practice Address - Street 2:BLDG. 200 SUITE 203
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7456
Practice Address - Country:US
Practice Address - Phone:352-624-2137
Practice Address - Fax:352-624-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7893251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health