Provider Demographics
NPI:1528389590
Name:CHILDREN AND FAMILY PLACE LLC
Entity Type:Organization
Organization Name:CHILDREN AND FAMILY PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LMHC
Authorized Official - Phone:407-697-9247
Mailing Address - Street 1:6220 S ORANGE BLOSSOM TRL STE 161
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4677
Mailing Address - Country:US
Mailing Address - Phone:407-697-9247
Mailing Address - Fax:
Practice Address - Street 1:6220 S ORANGE BLOSSOM TRL STE 161
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4677
Practice Address - Country:US
Practice Address - Phone:407-697-9247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1528389590Medicaid