| Age 0-20 Only | |
|
15311 Cortez Blvd Brooksville FL 34613-6005 | |
| (752) 540-9335 | |
| Not Available |
| Full Name | Age 0-20 Only |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 15311 Cortez Blvd, Brooksville, Florida |
| Authorized Official Name and Position | Lynda Gorken (VICE PRESIDENT) |
| Authorized Official Contact | 7272819390 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Age 0-20 Only 2995 Drew St Fl 2 Clearwater FL 33759-3012 Ph: (727) 281-9390 | Age 0-20 Only 15311 Cortez Blvd Brooksville FL 34613-6005 Ph: (752) 540-9335 |
| NPI Number | 1003190323 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 02/12/2020 |
| Certification Date | 02/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003190323 | NPI | - | NPPES |
| 060297311 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (Florida) | Primary |
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