Doctor Name: | MR. SANTIAGO FALLON |
NPI Number: | 1043360951 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | MH7320 |
Business Practice Address: | 1385 W State Road 434 Suite 103 Longwood, FL - 327506871 |
Business Phone Number: | 4074626133 |
Business Fax Number: | 4073326226 |
Mailing Address: | 230 E. Panama Rd., WINTER SPRINGS |
State: | FL |
Postal Code: | 32708 |
Phone Number: | 4074626133 |
Fax Number: | 4073326226 |
NPI Enumeration Date: | 01/11/2007 |
NPI Last Update Date: | 11/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH7320 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |