Provider Demographics
NPI:1669661831
Name:MEHRAVISTA HEALTH
Entity Type:Organization
Organization Name:MEHRAVISTA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-365-9634
Mailing Address - Street 1:32196 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3710
Mailing Address - Country:US
Mailing Address - Phone:727-781-2007
Mailing Address - Fax:
Practice Address - Street 1:32196 US HIGHWAY 19 N
Practice Address - Street 2:SUITE B
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3710
Practice Address - Country:US
Practice Address - Phone:727-781-2007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2348251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management