Provider Demographics
NPI:1487419396
Name:DAYTONA BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:DAYTONA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:772-584-0452
Mailing Address - Street 1:1635 S RIDGEWOOD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8425
Mailing Address - Country:US
Mailing Address - Phone:772-584-0452
Mailing Address - Fax:
Practice Address - Street 1:1635 S RIDGEWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8425
Practice Address - Country:US
Practice Address - Phone:772-584-0452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty