| Safe Harbor Clinic Llc | |
|
4013 Beatline Rd Ste A Long Beach MS 39560-4135 | |
| (228) 200-0720 | |
| Not Available |
| Full Name | Safe Harbor Clinic Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4013 Beatline Rd Ste A, Long Beach, Mississippi |
| Authorized Official Name and Position | Dustin Marmalich (OWNER) |
| Authorized Official Contact | 2284244425 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Safe Harbor Clinic Llc 4013 Beatline Rd Ste A Long Beach MS 39560-4135 Ph: (228) 200-0720 | Safe Harbor Clinic Llc 4013 Beatline Rd Ste A Long Beach MS 39560-4135 Ph: (228) 200-0720 |
| NPI Number | 1699242891 |
|---|---|
| Provider Enumeration Date | 10/26/2018 |
| Last Update Date | 10/26/2018 |
| Medicare PECOS PAC ID | 1759615693 |
|---|---|
| Medicare Enrollment ID | O20190626001020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699242891 | NPI | - | NPPES |
| Provider Name | Sandra J Spiers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518167949 PECOS PAC ID: 5597854885 Enrollment ID: I20071210000449 |
| Provider Name | Jennifer S Brechtel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649370503 PECOS PAC ID: 9638179435 Enrollment ID: I20100510000251 |
| Provider Name | Colleen Mcmahon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922559012 PECOS PAC ID: 8123395944 Enrollment ID: I20170530000368 |
| Provider Name | Dedra Terry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184089369 PECOS PAC ID: 3476842444 Enrollment ID: I20180416002169 |
| Provider Name | Dolores Bray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003852609 PECOS PAC ID: 0648370692 Enrollment ID: I20190625000530 |
| Provider Name | Lisa Parsons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356687396 PECOS PAC ID: 2264737873 Enrollment ID: I20190626001763 |
| Provider Name | Lynda R Formosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477665172 PECOS PAC ID: 6800973694 Enrollment ID: I20191029002975 |
| Provider Name | Rebekah Dess |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194379313 PECOS PAC ID: 0749677573 Enrollment ID: I20220426002910 |
| Provider Name | Lisa Collins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356090625 PECOS PAC ID: 7618364233 Enrollment ID: I20220429001417 |
| Provider Name | Penny Beth Taggart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326748740 PECOS PAC ID: 8628423910 Enrollment ID: I20231005002908 |
| Provider Name | Sarah Bienvenu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679297170 PECOS PAC ID: 0648627281 Enrollment ID: I20231103001602 |
| Provider Name | Daniel Stuart Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134844004 PECOS PAC ID: 5597112557 Enrollment ID: I20231113002248 |
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