MEDICARE: DIVERSIFIED BEHAVIORAL HEALTH SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467469890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED BEHAVIORAL HEALTH SOLUTIONS

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	BOWLING GREEN
State	:	FL
Zip	:	33834
Country	:	US
Telephone Number	:	863-375-2000
Fax Number	:	863-375-9929

Provider Business Practice Location Address
First Line	:	4705 US HIGHWAY 17 N
Second Line	:
City	:	BOWLING GREEN
State	:	FL
Zip	:	33834-5004
Country	:	US
Telephone Number	:	863-375-2000
Fax Number	:	863-375-9929

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. BRUCE MANSSUER
Credential	:
Telephone Number	:	863-781-7452

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/22/2020

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