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4545 Pleasant Hill Rd Ste 101 Kissimmee FL 34759-3400 | |
| (407) 895-0801 | |
| (407) 895-0803 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4545 Pleasant Hill Rd Ste 101, Kissimmee, Florida |
| Authorized Official Name and Position | Marucci Guzman (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4078950801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8617 E Colonial Dr Ste 1600 Orlando FL 32817-3937 Ph: (407) 895-0801 | 4545 Pleasant Hill Rd Ste 101 Kissimmee FL 34759-3400 Ph: (407) 895-0801 |
| NPI Number | 1205596350 |
|---|---|
| Provider Enumeration Date | 12/29/2021 |
| Last Update Date | 03/20/2023 |
| Certification Date | 03/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205596350 | NPI | - | NPPES |
| HCC13239 | Other | FL | HEALTH CARE CLINIC CERTIFICATE OF EXEMPTION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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