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General NPI Number Information
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NPI Number | 1356104269
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Entity Type | Organization
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Legal Business Name | TMS OF EMERALD COAST LLC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 403 HOLLYWOOD BLVD NW STE 103A
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4531
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Country | US
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Telephone | 801-245-0577
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Fax |
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Provider Business Mailing Address
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Address Line | 403 HOLLYWOOD BLVD NW STE 103A
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4531
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Country | US
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Telephone | 801-245-0577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MINDY MCCLELLAN
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Credential |
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Telephone | 801-245-0577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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