| Panhandle Therapy Center Llc | |
|
20311 Central Ave W Blountstown FL 32424-1947 | |
| (850) 674-8888 | |
| (850) 237-1223 |
| Full Name | Panhandle Therapy Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 20311 Central Ave W, Blountstown, Florida |
| Authorized Official Name and Position | Heather Montford King (DIRECTOR) |
| Authorized Official Contact | 8504474546 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Panhandle Therapy Center Llc 20311 Central Ave W Blountstown FL 32424-1947 Ph: (850) 674-8888 | Panhandle Therapy Center Llc 20311 Central Ave W Blountstown FL 32424-1947 Ph: (850) 674-8888 |
| NPI Number | 1457981888 |
|---|---|
| Provider Enumeration Date | 01/24/2020 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/20/2024 |
| Medicare PECOS PAC ID | 0446672489 |
|---|---|
| Medicare Enrollment ID | O20200622001928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457981888 | NPI | - | NPPES |
| Provider Name | Heather M King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992040034 PECOS PAC ID: 9335394329 Enrollment ID: I20130222000410 |
| Provider Name | Christina K Oliva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548607088 PECOS PAC ID: 5799926390 Enrollment ID: I20130724000514 |
| Provider Name | Glenn Graves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487848842 PECOS PAC ID: 8527229905 Enrollment ID: I20190212001072 |
| Provider Name | Jordon Marissa Gilbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215441290 PECOS PAC ID: 4587078894 Enrollment ID: I20210128000305 |
| Provider Name | Edward Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467035410 PECOS PAC ID: 7012373145 Enrollment ID: I20230516002344 |
| Provider Name | Maggie Mccaskill Foran |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770355232 PECOS PAC ID: 6709233158 Enrollment ID: I20231107003468 |
| Provider Name | Jason Glenn Tucker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194073601 PECOS PAC ID: 6406207844 Enrollment ID: I20240110000629 |
| Provider Name | Kenneth F Speights |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871967786 PECOS PAC ID: 2163874322 Enrollment ID: I20240123004734 |
Life Management Center Of Northwest Florida Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 16869 Ne Pear St, Blountstown, FL 32424 Phone: 850-522-4480 Fax: 850-914-6281 |