Healthcare Provider Details

I. General information

NPI: 1720470255
Provider Name (Legal Business Name): BAYER NEUROBEHAVIORAL CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VINE AVE NE
FORT WALTON BEACH FL
32548-5069
US

IV. Provider business mailing address

3 VINE AVE NE
FORT WALTON BEACH FL
32548-5069
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-7666
  • Fax: 850-266-7499
Mailing address:
  • Phone: 850-226-7666
  • Fax: 850-266-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY9214
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9440
License Number StateFL

VIII. Authorized Official

Name: DR. ZACHARY C BAYER
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PSYD
Phone: 850-226-7666