Provider Demographics
NPI:1487368569
Name:LEAD,EMPOWERED,SET,MENTAL HEALTH SERVICES,LLC
Entity type:Organization
Organization Name:LEAD,EMPOWERED,SET,MENTAL HEALTH SERVICES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRIL MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-301-1845
Mailing Address - Street 1:6925 LAKE ELLENOR DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4648
Mailing Address - Country:US
Mailing Address - Phone:407-552-5444
Mailing Address - Fax:
Practice Address - Street 1:6925 LAKE ELLENOR DR STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4648
Practice Address - Country:US
Practice Address - Phone:407-552-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116781200Medicaid