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General NPI Number Information
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NPI Number | 1114318573
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Entity Type | Organization
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Legal Business Name | AMIKIDS PANAMA CITY MARINE INSTITUTE, INC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 200 E BEACH DR
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City | PANAMA CITY
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State | FL
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Zip | 32401-3117
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Country | US
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Telephone | 850-258-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E BEACH DR
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City | PANAMA CITY
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State | FL
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Zip | 32401-3117
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Country | US
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Telephone | 850-258-1670
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RON BOYCE
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Credential |
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Telephone | 850-872-4715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10807
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License Number State | FL
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