1225606916 NPI number — COLLECTIVE BEHAVIORAL HEALTH LLC.

Table of content: (NPI 1225606916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225606916 NPI number — COLLECTIVE BEHAVIORAL HEALTH LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLECTIVE BEHAVIORAL HEALTH LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225606916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3455 ASTORIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32792-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-310-4485
Provider Business Mailing Address Fax Number:
717-427-4153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3455 ASTORIA CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-310-4485
Provider Business Practice Location Address Fax Number:
717-427-4153
Provider Enumeration Date:
06/17/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LELLO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-310-4485

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024361700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".