| Bodhi Tree Therapeutic Services | |
|
5512 Fairfax St Orlando FL 32812-7732 | |
| (202) 374-0573 | |
| Not Available |
| Full Name | Bodhi Tree Therapeutic Services |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 5512 Fairfax St, Orlando, Florida |
| Authorized Official Name and Position | Shakira Vasquez Moscoso (OWNER) |
| Authorized Official Contact | 2023740573 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bodhi Tree Therapeutic Services 5512 Fairfax St Orlando FL 32812-7732 Ph: (202) 374-0573 | Bodhi Tree Therapeutic Services 5512 Fairfax St Orlando FL 32812-7732 Ph: (202) 374-0573 |
| NPI Number | 1134855869 |
|---|---|
| Provider Enumeration Date | 07/26/2022 |
| Last Update Date | 07/26/2022 |
| Certification Date | 07/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134855869 | NPI | - | NPPES |
| MH17846 | Other | FL | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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