Organization
MELLOW JAC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIE PEREIRA (AUTHORIZED MEMBER)
(407) 615-0448
Entity
Organization
Contact information
Practice address
108 LILAC DR, KISSIMMEE, FL 34743-6345
(407) 734-3417
Mailing address
108 LILAC DR, KISSIMMEE, FL 34743-6345
(407) 734-3417
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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