Basic Information
| Provider Information | |||||||||
| NPI: | 1225376130 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BETTER LIFE BEHAVIORAL SERVICES OF CENTRAL FLORIDA, LLC | ||||||||
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| OtherOrganizationName: | BETTER LIFE BEHAVIORAL SERVICES OF CENTRAL FLORIDA, LLP | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 W MAIN ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347482842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027401287 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 W MAIN ST | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347482841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027401287 | ||||||||
| FaxNumber: | 3523142909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | GUERRERO | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | LYNNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3523143760 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-02-0775 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.