Healthcare Provider Details

I. General information

NPI: 1306993654
Provider Name (Legal Business Name): SUNCOAST BEHAVIORAL MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 S TAMIAMI TRL SUITE 241
SARASOTA FL
34231-3412
US

IV. Provider business mailing address

4370 S TAMIAMI TRL SUITE 241
SARASOTA FL
34231-3412
US

V. Phone/Fax

Practice location:
  • Phone: 941-926-2474
  • Fax: 941-926-2440
Mailing address:
  • Phone: 941-926-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4720
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 5729
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13914
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM BAKER
Title or Position: PRESIDENT
Credential: ED.D.
Phone: 941-926-2474