Organization
WISE FUTURE GROUP SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YAZNELLY S RIVERA MPA, MSCJ, CBHCMS (CEO)
(407) 508-7374
Entity
Organization
Contact information
Practice address
10244 E COLONIAL DR STE 110, ORLANDO, FL 32817-4365
(407) 202-9440
(407) 203-4710
Mailing address
2307 GREENWILLOW DR, ORLANDO, FL 32825-7572
(407) 508-7374
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016554600
—
FL
05
—
019545700
—
FL
05
—
101284000
—
FL
05
—
110159900
—
FL
05
—
110237900
—
FL
05
—
110561900
—
FL
Enumeration date
10/13/2020
Last updated
08/15/2024
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