Provider Demographics
NPI:1982303848
Name:HEAVENLY MINDS MENTAL HEALTH
Entity type:Organization
Organization Name:HEAVENLY MINDS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:BISONO
Authorized Official - Suffix:
Authorized Official - Credentials:AMS-I, MD
Authorized Official - Phone:917-940-4786
Mailing Address - Street 1:2117 BETSY ROSS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7099
Mailing Address - Country:US
Mailing Address - Phone:917-940-4786
Mailing Address - Fax:
Practice Address - Street 1:2117 BETSY ROSS LN
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7099
Practice Address - Country:US
Practice Address - Phone:917-940-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)