Provider Demographics
NPI:1740478627
Name:SEMINOLE COMMUNITY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:SEMINOLE COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-321-8908
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:
Mailing Address - Fax:
Practice Address - Street 1:351 S BAY AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2140
Practice Address - Country:US
Practice Address - Phone:407-321-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL323P00000X323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility