MEDICARE: MARVELLOUS BEHAVIORAL HEALTH AND MEDIATION, LLC

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	251S00000X	Community/Behavioral Health Agency	MH12363	FL

General Provider Information

NPI Number	:	1831600618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVELLOUS BEHAVIORAL HEALTH AND MEDIATION, LLC

Provider Business Mailing Address
First Line	:	1015 GRACE AVE STE B
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2494
Country	:	US
Telephone Number	:	850-215-1808
Fax Number	:	850-215-1895

Provider Business Practice Location Address
First Line	:	1015 GRACE AVE STE B
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2494
Country	:	US
Telephone Number	:	850-215-1808
Fax Number	:	850-215-1895

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARVEL L. ESTES
Credential	:	LMHC, CAP, NCC
Telephone Number	:	850-624-7898

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	09/19/2025

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