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General NPI Number Information
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NPI Number | 1487381901
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Entity Type | Organization
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Legal Business Name | UNCOMMON VALOR BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 1315 COUNTRY CLUB RD
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City | GULF BREEZE
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State | FL
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Zip | 32563-3451
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Country | US
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Telephone | 850-776-6619
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-9302
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Country | US
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Telephone | 850-776-6619
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE BERO
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Credential |
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Telephone | 850-776-6619
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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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