Provider Demographics
NPI:1669178349
Name:AMBER SCREEN THE EDUCATOR
Entity type:Organization
Organization Name:AMBER SCREEN THE EDUCATOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-777-3869
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-0982
Mailing Address - Country:US
Mailing Address - Phone:863-777-3869
Mailing Address - Fax:
Practice Address - Street 1:211 DORIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1006
Practice Address - Country:US
Practice Address - Phone:863-777-3869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health