Provider Demographics
NPI:1306583083
Name:MY MENTAL HEALTH SOLUTIONS
Entity type:Organization
Organization Name:MY MENTAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-393-0315
Mailing Address - Street 1:3083 NEVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA
Mailing Address - State:FL
Mailing Address - Zip Code:32168-2442
Mailing Address - Country:US
Mailing Address - Phone:786-393-0315
Mailing Address - Fax:
Practice Address - Street 1:801 INTERNATIONAL PARKWAY
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4762
Practice Address - Country:US
Practice Address - Phone:786-393-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109795800Medicaid