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General NPI Number Information
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NPI Number | 1144877424
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Entity Type | Organization
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Legal Business Name | GULFSHORE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 11/12/2023
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Provider Practice Location Address
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Address Line | 1555 MATTHEW DR
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City | FORT MYERS
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State | FL
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Zip | 33907-1734
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Country | US
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Telephone | 239-533-9860
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 MATTHEW DR
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City | FORT MYERS
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State | FL
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Zip | 33907-1734
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Country | US
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Telephone | 239-533-9860
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED PSYCHOLOGIST
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Name | DR. SAMANTHA DENBOER
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Credential |
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Telephone | 239-533-9860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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