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135 Largs Ct #308 Dunedin FL 34698-8386 | |
| (863) 214-2046 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 135 Largs Ct, Dunedin, Florida |
| Authorized Official Name and Position | Phillip Edward Van Kleeck (OWNER / ADMINISTRATOR) |
| Authorized Official Contact | 8632142046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
135 Largs Ct #308 Dunedin FL 34698-8386 Ph: (863) 214-2046 | 135 Largs Ct #308 Dunedin FL 34698-8386 Ph: (863) 214-2046 |
| NPI Number | 1801345335 |
|---|---|
| Provider Enumeration Date | 09/26/2016 |
| Last Update Date | 09/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801345335 | NPI | - | NPPES |
| 1093990016 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH9545 (Florida) | Primary |
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