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Organization
LAKE PSYCHOEDUCATIONAL CENTER
Active
Organization
LAKE PSYCHOEDUCATIONAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE PENA PSY.D, LMHC (PRESIDENT)
(407) 209-7492
Entity
Organization
Contact information
Practice address
600 N HIGHWAY 27 STE 1, MINNEOLA, FL 34715-6265
(407) 209-7492
(352) 241-8372
Mailing address
600 N HIGHWAY 27 STE 1, MINNEOLA, FL 34715-6265
(407) 209-7492
(352) 241-8372
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH5773
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
762627400
—
FL
Enumeration date
03/26/2015
Last updated
03/26/2015
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