| |
2557 Sherman Oak Dr North Port FL 34289-2390 | |
(573) 776-0578 | |
Not Available |
Full Name | |
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Speciality | Psychologist - Clinical |
Location | 2557 Sherman Oak Dr, North Port, Florida |
Authorized Official Name and Position | Roger Dale Davis (OWNER) |
Authorized Official Contact | 5737760578 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2557 Sherman Oak Dr North Port FL 34289-2390 Ph: (573) 776-0578 | 2557 Sherman Oak Dr North Port FL 34289-2390 Ph: (573) 776-0578 |
NPI Number | 1164103446 |
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Provider Enumeration Date | 07/28/2023 |
Last Update Date | 11/15/2023 |
Certification Date | 11/15/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164103446 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
Centerplace Health, Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6919 Outreach Way, North Port, FL 34287 Phone: 941-529-0200 | |
Pediatric Behavioral Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4160 Oceanside St, North Port, FL 34286 Phone: 863-529-2183 |