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Organization

CENTER FOR BEHAVIORAL MEDICINE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHANE PORTER (MANAGING PARTNER)
13869573905
Entity
Organization

Contact information

Practice address
1730 DUNLAWTON AVE, SUITE 3, PORT ORANGE, FL 32127-8985
(138) 695-7390
Mailing address
1730 DUNLAWTON AVE, SUITE 3, PORT ORANGE, FL 32127-8985

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH6409
FL

Other

Enumeration date
03/31/2017
Last updated
03/31/2017
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