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General NPI Number Information
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NPI Number | 1699029017
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Entity Type | Organization
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Legal Business Name | SUNCOAST MENTAL HELATH
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 2814 SOUTH U.S HIGHWAY 1, SUITE D4
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City | FORT PIERCE
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State | FL
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Zip | 34982
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Country | US
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Telephone | 718-679-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 S US HIGHWAY 1 STE D4
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City | FORT PIERCE
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State | FL
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Zip | 34982-8110
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Country | US
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Telephone | 718-679-6334
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Fax | 772-489-0423
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. MARJORIE MARIE TIME
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Credential |
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Telephone | 718-679-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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