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General NPI Number Information
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NPI Number | 1679205025
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Entity Type | Organization
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Legal Business Name | SEASIDE BEHAVIORAL HEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 611 SW FEDERAL HWY STE C
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City | STUART
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State | FL
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Zip | 34994-2925
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Country | US
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Telephone | 772-678-6045
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Fax |
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Provider Business Mailing Address
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Address Line | 611 SW FEDERAL HWY STE C
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City | STUART
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State | FL
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Zip | 34994-2925
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Country | US
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Telephone | 772-678-6045
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. NYAISHA CUMMINGS
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Credential | RN
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Telephone | 772-678-6045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 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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