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General NPI Number Information
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NPI Number | 1689298341
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Entity Type | Organization
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Legal Business Name | MCMAKEN COUNSELING AND SUPPORT SERVICES
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 415 N RICHARD JACKSON BLVD STE 206B
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3694
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Country | US
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Telephone | 303-618-5614
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Fax | 850-248-2469
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Provider Business Mailing Address
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Address Line | 415 N RICHARD JACKSON BLVD STE 206B
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-3694
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Country | US
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Telephone | 303-618-5614
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Fax | 850-248-2469
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. SANDI GAY
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Credential |
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Telephone | 850-248-2468
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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 |
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License Number State |
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