Center for Independent Living in Central Florida

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MH8933 Issued in FL

Legal business name

CENTER FOR INDEPENDENT LIVING IN CENTRAL FLORIDA

Practice address

720 N. Denning Dr.
Winter Park, FL 32789

Phone

(407) 623-1070

Fax

(407) 623-1390

NPI assigned

Oct 26, 2009

Last updated

Oct 26, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Tina P Jack, MS

Title

Mental Health Counselor

Phone

(407) 623-1070

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1256515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256515200000",
    "number": "1093041154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N. DENNING DR.",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "32789",
            "telephone_number": "407-623-1070",
            "fax_number": "407-623-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N. DENNING DR.",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "32789",
            "telephone_number": "407-623-1070",
            "fax_number": "407-623-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR INDEPENDENT LIVING IN CENTRAL FLORIDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-26",
        "last_updated": "2009-10-26",
        "status": "A",
        "authorized_official_last_name": "JACK",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MENTAL HEALTH COUNSELOR",
        "authorized_official_telephone_number": "407-623-1070",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "MH8933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2009; 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.