NPIMap

Organization Active NPI

Center for Behavioral Medicine

  • Mental Health Counselor
  • Port Orange, FL
National Provider Identifier
1003348855
Registry record updated Mar 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH6409 Issued in FL
Legal business name
CENTER FOR BEHAVIORAL MEDICINE
Practice address
1730 Dunlawton Ave
Suite 3
Port Orange, FL 32127-8985
Phone
(138) 695-7390
NPI assigned
Mar 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shane Porter
Title
Managing Partner
Phone
(386) 957-3905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X MH6409 FL Primary

Addresses

Primary practice location

1730 Dunlawton Ave
Suite 3
Port Orange, FL 32127-8985

Mailing address

1730 Dunlawton Ave
Suite 3
Port Orange, FL 32127-8985

National Provider Directory

National Provider Directory
Tax ID family
Center for Behavioral Medicine2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490918400000",
    "number": "1003348855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 DUNLAWTON AVE",
            "address_2": "SUITE 3",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 DUNLAWTON AVE",
            "address_2": "SUITE 3",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278985",
            "telephone_number": "138-695-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR BEHAVIORAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-31",
        "last_updated": "2017-03-31",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "13869573905"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH6409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.