Provider Demographics
NPI: | 1922823145 |
---|---|
Name: | SEASONS OF WELLNESS INC. |
Entity type: | Organization |
Organization Name: | SEASONS OF WELLNESS INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JUNE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRAFT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | APRN |
Authorized Official - Phone: | 606-260-9836 |
Mailing Address - Street 1: | 26619 W COVE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | TAVARES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32778-9711 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-260-9836 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2044 E ORANGE AVE |
Practice Address - Street 2: | |
Practice Address - City: | EUSTIS |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32726-4418 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-763-3877 |
Practice Address - Fax: | 352-329-4378 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-11-21 |
Last Update Date: | 2025-04-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |