Amanda J Collister, LMHC | |
1239 E Main St, Bartow, FL 33830-5058 | |
(863) 519-0575 | |
Not Available |
Full Name | Amanda J Collister |
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Gender | Female |
Speciality | Counselor - Mental Health |
Location | 1239 E Main St, Bartow, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1255723623 | NPI | - | NPPES |
016650700 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | MH13971 (Florida) | Primary |
Entity Name | Peace River Center For Personal Development Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1821097767 PECOS PAC ID: 7719877927 Enrollment ID: O20040319000056 |
Mailing Address | Practice Location Address |
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Amanda J Collister, LMHC Po Box 1559, Bartow, FL 33831-1559 Ph: () - | Amanda J Collister, LMHC 1239 E Main St, Bartow, FL 33830-5058 Ph: (863) 519-0575 |
Youlaunda Lashawn Wright-speed, Counselor Medicare: Not Enrolled in Medicare Practice Location: 555 Forrest Dr, Bartow, FL 33830 Phone: 863-440-6230 | |
Jessica Little, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1255 Golfview Ave, Bartow, FL 33830 Phone: 863-519-0575 Fax: 863-582-9251 | |
Travis Risner, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1255 Golfview Ave, Bartow, FL 33830 Phone: 863-519-0575 Fax: 863-582-9251 | |
Myriam M Buitrago, LMHC Counselor Medicare: Medicare Enrolled Practice Location: 1239 E Main St, Bartow, FL 33830 Phone: 863-519-0575 | |
Chad Feacher, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1255 Golfview Ave, Bartow, FL 33830 Phone: 863-519-0575 | |
Joni Irene Nelson, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 495 S Central Ave, Bartow, FL 33830 Phone: 863-585-3247 | |
Michael Scott Smith, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1239 E Main St, Bartow, FL 33830 Phone: 863-519-0575 |