1851561617 NPI number — MR. ANDRAI HAK MENTAL HEALTH COUNSE

Table of content: MR. ANDRAI HAK MENTAL HEALTH COUNSE (NPI 1851561617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851561617 NPI number — MR. ANDRAI HAK MENTAL HEALTH COUNSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAK
Provider First Name:
ANDRAI
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MENTAL HEALTH COUNSE
Provider Gender Code:
M

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:
1851561617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4715 LIGHTHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32808-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-438-4032
Provider Business Mailing Address Fax Number:
407-578-3961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 ALOMA AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32792-3662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-975-0400
Provider Business Practice Location Address Fax Number:
407-696-4831
Provider Enumeration Date:
03/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  IMH6213 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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