Healthcare Provider Details

I. General information

NPI: 1801508437
Provider Name (Legal Business Name): FLORIDA TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5713 HIGHWAY 85 N
CRESTVIEW FL
32536-9008
US

IV. Provider business mailing address

13553 STATE ROUTE 54 STE 309
ODESSA FL
33556
US

V. Phone/Fax

Practice location:
  • Phone: 850-801-1379
  • Fax: 833-411-1264
Mailing address:
  • Phone: 727-284-8618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY COPLIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 727-284-8618