Provider Demographics
NPI:1487867982
Name:SEMINOLE COMMUNITY MENTAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SEMINOLE COMMUNITY MENTAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRISIS SUPPORT SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:CASSANDRA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER'S DEGREE
Authorized Official - Phone:407-321-4357
Mailing Address - Street 1:5713 CREEKDALE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810
Mailing Address - Country:US
Mailing Address - Phone:407-297-1811
Mailing Address - Fax:
Practice Address - Street 1:5713 CREEK DALE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-3981
Practice Address - Country:US
Practice Address - Phone:407-297-1811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty