Organization
ALIVE & WELL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELLISSA LATOYA JAGRUP LMHC (PROPRIETER)
(813) 748-2912
Entity
Organization
Contact information
Practice address
10344 VISTA PINES LOOP, CLERMONT, FL 34711-9172
(813) 748-2912
Mailing address
PO BOX 120682, CLERMONT, FL 34712-0682
(813) 748-2912
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH9648
FL
251S00000X
Community/Behavioral Health Agency
MH9648
FL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
MH9648
FL
Other
Enumeration date
09/29/2017
Last updated
09/29/2017
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