Provider Demographics
NPI:1851618425
Name:SEMINOLE BEHAVIOR HEALTH
Entity Type:Organization
Organization Name:SEMINOLE BEHAVIOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLUBHOUSE PROGRAM SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TARISHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-401-4675
Mailing Address - Street 1:237 FERNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2116
Mailing Address - Country:US
Mailing Address - Phone:407-831-2411
Mailing Address - Fax:407-831-0195
Practice Address - Street 1:3590 N. HYW 17-92
Practice Address - Street 2:1026
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:402-321-7015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health