Organization Name: | BRILLIANT MINDS |
NPI Number: | 1720101736 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GINA M BALLONE (CLINCAL DIRECTOR) |
Mailing Address: | 36468 Emerald Coast Pkwy Suite 2101 Destin |
State: | FL US |
Postal Code: | 325414799 |
Phone Number: | 8508371200 |
Fax Number: | 8502692341 |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 90051001284 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |