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General NPI Number Information
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NPI Number | 1891105573
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Entity Type | Organization
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Legal Business Name | BACOT ACADEMY
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 3704 W 23RD ST SUITE D
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City | PANAMA CITY
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State | FL
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Zip | 32405-1371
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Country | US
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Telephone | 850-215-2614
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Fax |
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Provider Business Mailing Address
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Address Line | 3704 W 23RD ST SUITE D
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City | PANAMA CITY
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State | FL
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Zip | 32405-1371
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Country | US
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Telephone | 850-215-2614
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CINDY KIMBRELL BACOT
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Credential |
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Telephone | 850-215-2614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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