Southeastern Behavioral Health, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY10048 Issued in FL

Legal business name

SOUTHEASTERN BEHAVIORAL HEALTH, LLC

Practice address

3303 Thomasville Rd Ste 102
Tallahassee, FL 32308-7912

Phone

(850) 296-3665

Fax

(850) 296-3665

NPI assigned

May 14, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Angela Canto, PH.D.

Title

Owner/Authorized Representative

Phone

(850) 296-3665

Specialties & licenses 2

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Douglas Bennett, ED.S.

  • School Psychologist
  • Tallahassee, FL
  • NPI 1255031696
  NPD
• Joyce Marguerite Overstreet, ED.S

  • School Psychologist
  • Tallahassee, FL
  • NPI 1265909022
  NPD
• Katherine Dickinson

  • Psychologist
  • Tallahassee, FL
  • NPI 1629585765
  NPD (past)

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577491200000",
    "number": "1689164790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 THOMASVILLE RD STE 102",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087912",
            "telephone_number": "850-296-3665",
            "fax_number": "850-296-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 THOMASVILLE RD STE 102",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087912",
            "telephone_number": "850-296-3665",
            "fax_number": "850-296-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-14",
        "last_updated": "2019-12-28",
        "certification_date": "2019-12-28",
        "status": "A",
        "authorized_official_last_name": "CANTO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "850-296-3665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY10048",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS1033",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soulistic Counseling & Therapeutic Services
• Jennifer Sousa
• Southeast Radiology Partners LTD
• Southeast Radiology Partners LTD
• Southeast Radiology Partners LTD (Radiology Associates of Tallahassee)
• Southeastern Center for Infectious Diseases PA
• Southeastern Dermatology, PA
• Southeastern Outpatient Surgery Center LLC
• Southeastern Plastic Surgery, P.a. (Southeastern Plastic Surgery)
• Southeastern Podiatry Clinic PA

• Psychologist in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2019; 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.