Provider Demographics
NPI:1740659739
Name:DMV BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:DMV BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-780-0500
Mailing Address - Street 1:662 YOUNGSTOWN PKWY
Mailing Address - Street 2:#202
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4529
Mailing Address - Country:US
Mailing Address - Phone:407-780-0500
Mailing Address - Fax:
Practice Address - Street 1:662 YOUNGSTOWN PKWY
Practice Address - Street 2:#202
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4529
Practice Address - Country:US
Practice Address - Phone:407-780-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health