| Cerebellum - Primary Care | |
|
8146 Cerebellum Way Suite 102 Trinity FL 34655-1784 | |
| (727) 359-0893 | |
| Not Available |
| Full Name | Cerebellum - Primary Care |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 8146 Cerebellum Way, Trinity, 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 |
|---|---|
| Cerebellum - Primary Care 2995 Drew St Fl 2 Clearwater FL 33759-3012 Ph: (727) 281-9390 | Cerebellum - Primary Care 8146 Cerebellum Way Suite 102 Trinity FL 34655-1784 Ph: (727) 359-0893 |
| NPI Number | 1164790648 |
|---|---|
| Provider Enumeration Date | 12/12/2011 |
| Last Update Date | 02/12/2020 |
| Certification Date | 02/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164790648 | NPI | - | NPPES |
| 060297320 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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