Provider Demographics
NPI:1467469890
Name:DIVERSIFIED BEHAVIORAL HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:DIVERSIFIED BEHAVIORAL HEALTH SOLUTIONS
Other - Org Name:CENTRAL FLORIDA YOUTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSSUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-781-7452
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834
Mailing Address - Country:US
Mailing Address - Phone:863-375-2000
Mailing Address - Fax:863-375-9929
Practice Address - Street 1:4705 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:FL
Practice Address - Zip Code:33834-5004
Practice Address - Country:US
Practice Address - Phone:863-375-2000
Practice Address - Fax:863-375-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty