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General NPI Number Information
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NPI Number | 1922562628
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Entity Type | Organization
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Legal Business Name | BLUEWATER BEHAVIORAL HEALTH INC
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Dates
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Enumeration Date | 01/27/2019
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 4400 E HIGHWAY 20 STE 208
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City | NICEVILLE
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State | FL
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Zip | 32578-9735
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Country | US
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Telephone | 575-520-1230
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Fax | 773-492-8765
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Provider Business Mailing Address
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Address Line | 4515 PARKVIEW LN
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City | NICEVILLE
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State | FL
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Zip | 32578-8734
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Country | US
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Telephone | 423-930-4667
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LEIGH GAYLE POWERS
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 850-797-2598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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