| Behavioral Mind Wellness: Evaluation, Prevention & Treatment | |
|
417 W Vine St Kissimmee FL 34741-4154 | |
| (321) 888-6965 | |
| (407) 978-6520 |
| Full Name | Behavioral Mind Wellness: Evaluation, Prevention & Treatment |
|---|---|
| Speciality | Psychologist |
| Location | 417 W Vine St, Kissimmee, Florida |
| Authorized Official Name and Position | Carmen C Capella (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3218886965 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Mind Wellness: Evaluation, Prevention & Treatment 417 W Vine St Kissimmee FL 34741-4154 Ph: (321) 888-6965 | Behavioral Mind Wellness: Evaluation, Prevention & Treatment 417 W Vine St Kissimmee FL 34741-4154 Ph: (321) 888-6965 |
| NPI Number | 1902432339 |
|---|---|
| Provider Enumeration Date | 03/17/2020 |
| Last Update Date | 11/04/2021 |
| Certification Date | 11/04/2021 |
| Medicare PECOS PAC ID | 6901222090 |
|---|---|
| Medicare Enrollment ID | O20200819004181 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902432339 | NPI | - | NPPES |
| 024947100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carmen C Capella |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013088681 PECOS PAC ID: 8628254653 Enrollment ID: I20180821001396 |
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