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1253 Holliday Dr Gulf Breeze FL 32563-2529 | |
| (850) 220-8339 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1253 Holliday Dr, Gulf Breeze, Florida |
| Authorized Official Name and Position | Holiday Whisenant (OWNER) |
| Authorized Official Contact | 8502873574 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1253 Holliday Dr Gulf Breeze FL 32563-2529 Ph: (850) 220-8339 | 1253 Holliday Dr Gulf Breeze FL 32563-2529 Ph: (850) 220-8339 |
| NPI Number | 1063157246 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 11/10/2022 |
| Certification Date | 11/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063157246 | NPI | - | NPPES |
| 009555800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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