| Dandelion Behavioral Health Llc | |
|
1777 Tamiami Trl Port Charlotte FL 33948-1078 | |
| (941) 780-4268 | |
| Not Available |
| Full Name | Dandelion Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1777 Tamiami Trl, Port Charlotte, Florida |
| Authorized Official Name and Position | Tamara Tridle (OWNER) |
| Authorized Official Contact | 9417804268 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dandelion Behavioral Health Llc 25443 Estrada Circle Punta Gorda FL 33955 Ph: (402) 217-4555 | Dandelion Behavioral Health Llc 1777 Tamiami Trl Port Charlotte FL 33948-1078 Ph: (941) 780-4268 |
| NPI Number | 1053028787 |
|---|---|
| Provider Enumeration Date | 11/02/2022 |
| Last Update Date | 02/25/2025 |
| Certification Date | 02/25/2025 |
| Medicare PECOS PAC ID | 9739600685 |
|---|---|
| Medicare Enrollment ID | O20250307000590 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053028787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Joel Anthony Pieper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932652260 PECOS PAC ID: 8628599586 Enrollment ID: I20250307000676 |
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