|
| |
|
9400 4th St N Ste 200 St Petersburg FL 33702-2501 | |
| (727) 513-2962 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 9400 4th St N Ste 200, St Petersburg, Florida |
| Authorized Official Name and Position | Katherine Planchard (CLINIC DIRECTOR) |
| Authorized Official Contact | 5082126095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
324 N Bay Hills Blvd Safety Harbor FL 34695-4905 Ph: (717) 608-0329 | 9400 4th St N Ste 200 St Petersburg FL 33702-2501 Ph: (727) 513-2962 |
| NPI Number | 1972218055 |
|---|---|
| Provider Enumeration Date | 01/23/2023 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Medicare PECOS PAC ID | 5496290033 |
|---|---|
| Medicare Enrollment ID | O20240708003623 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972218055 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jatharine Mercado |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124673702 PECOS PAC ID: 3870941883 Enrollment ID: I20231201001612 |
| Provider Name | Kirby Kelleher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447814645 PECOS PAC ID: 8527408640 Enrollment ID: I20240506003368 |
| Provider Name | Dominique Jalisia Mickler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710741343 PECOS PAC ID: 3476098021 Enrollment ID: I20240708004197 |
| Provider Name | Katherine Planchard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992259279 PECOS PAC ID: 9931644572 Enrollment ID: I20240709000914 |
| Provider Name | Aaron Lee Warren |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528707015 PECOS PAC ID: 0840735239 Enrollment ID: I20240710000803 |
| Provider Name | Millie Joan Ito Cuevas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811161540 PECOS PAC ID: 8022557289 Enrollment ID: I20240831000361 |
| Provider Name | Kristian Nicole Berger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013308402 PECOS PAC ID: 5698216372 Enrollment ID: I20240920003402 |
Rosana O'neill, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5628 36th Ave N, St Petersburg, FL 33710 Phone: 727-424-1578 | |
Anxiety Treatment Specialists Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7901 4th St N # 17648, St Petersburg, FL 33702 Phone: 239-376-1953 | |
Florida Advocacy Group, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7901 4th St N Ste 300, St Petersburg, FL 33702 Phone: 813-576-9914 Fax: 813-212-4418 | |
Apt Associates - A Consult Group Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 695 Central Ave, Ste 150f, St Petersburg, FL 33701 Phone: 727-490-2020 Fax: 727-490-2015 | |
The Luminescent Mind, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7901 4th St N Ste 4000, St Petersburg, FL 33702 Phone: 786-266-0108 |