| 2nd Chance Mental Health Center, Llc | |
|
1541 Se Port St Lucie Blvd Suite F Port St Lucie FL 34952-5456 | |
| (772) 335-0166 | |
| Not Available |
| Full Name | 2nd Chance Mental Health Center, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1541 Se Port St Lucie Blvd, Port St Lucie, Florida |
| Authorized Official Name and Position | Johnny Brown (CEO/OWNER) |
| Authorized Official Contact | 7723350166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 2nd Chance Mental Health Center, Llc 1541 Se Port St Lucie Blvd Suite F Port St Lucie FL 34952-5456 Ph: (772) 335-0166 | 2nd Chance Mental Health Center, Llc 1541 Se Port St Lucie Blvd Suite F Port St Lucie FL 34952-5456 Ph: (772) 335-0166 |
| NPI Number | 1942518246 |
|---|---|
| Provider Enumeration Date | 09/21/2010 |
| Last Update Date | 05/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942518246 | NPI | - | NPPES |
| 003355500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW9510 (Florida) | Primary |
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