| Beverly Wilusz | |
|
228 Brooks St Se Ste A Fort Walton Beach FL 32548-2821 | |
| (850) 301-0446 | |
| (850) 301-0442 |
| Full Name | Beverly Wilusz |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 228 Brooks St Se Ste A, Fort Walton Beach, Florida |
| Authorized Official Name and Position | Beverly Wilusz (OWNER) |
| Authorized Official Contact | 8503010446 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beverly Wilusz Po Box 846 Fort Walton Beach FL 32549-0846 Ph: (850) 301-0446 | Beverly Wilusz 228 Brooks St Se Ste A Fort Walton Beach FL 32548-2821 Ph: (850) 301-0446 |
| NPI Number | 1275946535 |
|---|---|
| Provider Enumeration Date | 06/04/2014 |
| Last Update Date | 06/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275946535 | NPI | - | NPPES |
| MH-2007 | Other | FL | FLORIDA BLUE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH-2007 (Florida) | Primary |
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