| Creekside Psychiatric Center Pa | |
|
5190 Bayou Blvd Ste 6 Pensacola FL 32503-2162 | |
| (850) 476-0977 | |
| (850) 476-2558 |
| Full Name | Creekside Psychiatric Center Pa |
|---|---|
| Speciality | Counselor |
| Location | 5190 Bayou Blvd Ste 6, Pensacola, Florida |
| Authorized Official Name and Position | Lisa Ann Weekley (OFFICE MANAGER) |
| Authorized Official Contact | 8504760977 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creekside Psychiatric Center Pa 5190 Bayou Blvd Ste 6 Pensacola FL 32503-2162 Ph: (850) 476-0977 | Creekside Psychiatric Center Pa 5190 Bayou Blvd Ste 6 Pensacola FL 32503-2162 Ph: (850) 476-0977 |
| NPI Number | 1225330897 |
|---|---|
| Provider Enumeration Date | 12/02/2010 |
| Last Update Date | 12/02/2010 |
| Medicare PECOS PAC ID | 5597933903 |
|---|---|
| Medicare Enrollment ID | O20110729000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225330897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Wendy M Depury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275626152 PECOS PAC ID: 7113119694 Enrollment ID: I20101004000562 |
| Provider Name | Robert S Benson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316947377 PECOS PAC ID: 2365435476 Enrollment ID: I20110729000024 |
| Provider Name | Henry H Dohn |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407857956 PECOS PAC ID: 0941478358 Enrollment ID: I20110729000085 |
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