| Daytona Behavioral Health Llc | |
|
1635 S Ridgewood Ave Ste 201 South Daytona FL 32119-8425 | |
| (772) 584-0452 | |
| Not Available |
| Full Name | Daytona Behavioral Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 1635 S Ridgewood Ave Ste 201, South Daytona, Florida |
| Authorized Official Name and Position | Shannon Miller (OWNER) |
| Authorized Official Contact | 7725840452 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Daytona Behavioral Health Llc 1635 S Ridgewood Ave Ste 201 South Daytona FL 32119-8425 Ph: (772) 584-0452 | Daytona Behavioral Health Llc 1635 S Ridgewood Ave Ste 201 South Daytona FL 32119-8425 Ph: (772) 584-0452 |
| NPI Number | 1487419396 |
|---|---|
| Provider Enumeration Date | 02/20/2024 |
| Last Update Date | 02/20/2024 |
| Certification Date | 02/20/2024 |
| Medicare PECOS PAC ID | 1658719166 |
|---|---|
| Medicare Enrollment ID | O20240403001546 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487419396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shannon M Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770821944 PECOS PAC ID: 3476991985 Enrollment ID: I20240403002595 |
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