| Radical Wellness Pllc | |
|
4729 Us-98 S Suite 104 Lakeland FL 33812 | |
| (813) 444-7576 | |
| Not Available |
| Full Name | Radical Wellness Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 4729 Us-98 S, Lakeland, Florida |
| Authorized Official Name and Position | Megan Cherry (OWNER) |
| Authorized Official Contact | 8134447576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radical Wellness Pllc 2424 W Brandon Blvd # 1129 Brandon FL 33511-4717 Ph: (813) 444-7576 | Radical Wellness Pllc 4729 Us-98 S Suite 104 Lakeland FL 33812 Ph: (813) 444-7576 |
| NPI Number | 1033849815 |
|---|---|
| Provider Enumeration Date | 06/14/2022 |
| Last Update Date | 06/14/2022 |
| Certification Date | 06/07/2022 |
| Medicare PECOS PAC ID | 9537532544 |
|---|---|
| Medicare Enrollment ID | O20230222000719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033849815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Marcus Cherry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174279988 PECOS PAC ID: 3173996188 Enrollment ID: I20230222000798 |
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