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NPI Code Detail

MEDICARE: DAVID LAWRENCE MENTAL HEALTH CENTER, INC

MEDICARE: DAVID LAWRENCE MENTAL HEALTH CENTER, INC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801891940
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID LAWRENCE MENTAL HEALTH CENTER, INC
Provider Business Mailing Address
First Line : 6075 BATHEY LN
Second Line :
City : NAPLES
State : FL
Zip : 34116-7536
Country : US
Telephone Number : 239-455-8500
Fax Number : 239-455-6561
Provider Business Practice Location Address
First Line : 6075 BATHEY LN
Second Line :
City : NAPLES
State : FL
Zip : 34116-7536
Country : US
Telephone Number : 239-455-8500
Fax Number : 239-455-6561
Authorized Official
Title or Position : CEO
Name : SCOTT BURGESS
Credential :
Telephone Number : 239-455-8500
Provider Enumeration Date : 06/16/2005
Last Update Date : 03/18/2020

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