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7901 4th Ave St N. Suite #300 St Petersburg FL 33702 | |
| (941) 347-0623 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 7901 4th Ave St N., St Petersburg, Florida |
| Authorized Official Name and Position | Audra Glunt (OWNER) |
| Authorized Official Contact | 9413470623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12161 Mercado Dr Pmb 409 Venice FL 34293-4399 Ph: (941) 347-0623 | 7901 4th Ave St N. Suite #300 St Petersburg FL 33702 Ph: (941) 347-0623 |
| NPI Number | 1396527917 |
|---|---|
| Provider Enumeration Date | 10/18/2023 |
| Last Update Date | 02/04/2025 |
| Certification Date | 01/29/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396527917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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