| The Wave International Llc | |
|
9215 Causeway Blvd Tampa FL 33619-6608 | |
| (727) 612-4907 | |
| Not Available |
| Full Name | The Wave International Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 9215 Causeway Blvd, Tampa, Florida |
| Authorized Official Name and Position | Ashlee T Bryant (COO) |
| Authorized Official Contact | 7276124907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Wave International Llc 28059 Us Highway 19 N Ste 205 Clearwater FL 33761-2620 Ph: () - | The Wave International Llc 9215 Causeway Blvd Tampa FL 33619-6608 Ph: (727) 612-4907 |
| NPI Number | 1528748613 |
|---|---|
| Provider Enumeration Date | 07/24/2023 |
| Last Update Date | 04/12/2024 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 9436563376 |
|---|---|
| Medicare Enrollment ID | O20210329001266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528748613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 3104A0625X | Assisted Living Facility - Assisted Living, Mental Illness | (* (Not Available)) | Secondary |
| Provider Name | Hassan Ayaz Bokhari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811158082 PECOS PAC ID: 2062653462 Enrollment ID: I20150721002094 |
| Provider Name | Lauren A Baer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821426123 PECOS PAC ID: 1153784947 Enrollment ID: I20230827000124 |
| Provider Name | Lara Janine Joynes-whidden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437292547 PECOS PAC ID: 9032564364 Enrollment ID: I20231006000441 |
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