| Mid State Mental Health Assessment Inc | |
|
7052 Annunciation Circle Suite 329 Ave Maria FL 34142-0000 | |
| (239) 352-4004 | |
| Not Available |
| Full Name | Mid State Mental Health Assessment Inc |
|---|---|
| Speciality | Psychologist |
| Location | 7052 Annunciation Circle, Ave Maria, Florida |
| Authorized Official Name and Position | Bruce Edward Malcolm (PRESIDENT) |
| Authorized Official Contact | 2393524004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid State Mental Health Assessment Inc 5819 Plymouth Pl Ave Maria FL 34142-9586 Ph: (239) 352-4004 | Mid State Mental Health Assessment Inc 7052 Annunciation Circle Suite 329 Ave Maria FL 34142-0000 Ph: (239) 352-4004 |
| NPI Number | 1215262977 |
|---|---|
| Provider Enumeration Date | 10/13/2009 |
| Last Update Date | 02/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215262977 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY8461 (Florida) | Primary |
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