Healthcare Provider Details

I. General information

NPI: 1225046550
Provider Name (Legal Business Name): SUNCOAST MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 COLONIAL RD STE 100
FORT PIERCE FL
34950-5309
US

IV. Provider business mailing address

2222 COLONIAL RD STE 100
FORT PIERCE FL
34950-5309
US

V. Phone/Fax

Practice location:
  • Phone: 772-489-4726
  • Fax: 772-466-5578
Mailing address:
  • Phone: 772-489-4726
  • Fax: 772-466-5578

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHAELENE REESE
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 772-489-4726