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941 W Morse Blvd Suite 100 Winter Park FL 32789-3734 | |
| (407) 896-3345 | |
| (407) 502-2778 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 941 W Morse Blvd, Winter Park, Florida |
| Authorized Official Name and Position | Lawrence Stuart Cody (MANAGING MEMBER) |
| Authorized Official Contact | 4078963345 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 541535 Orlando FL 32854-1535 Ph: (407) 896-3345 | 941 W Morse Blvd Suite 100 Winter Park FL 32789-3734 Ph: (407) 896-3345 |
| NPI Number | 1568901932 |
|---|---|
| Provider Enumeration Date | 02/18/2017 |
| Last Update Date | 02/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568901932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | MH0002741 (Florida) | Primary |
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