| Kmg Behavioral Health Services Llc | |
|
15165 Michelangelo Blvd Apt 207 Delray Beach FL 33446-6026 | |
| (561) 927-9442 | |
| Not Available |
| Full Name | Kmg Behavioral Health Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 15165 Michelangelo Blvd Apt 207, Delray Beach, Florida |
| Authorized Official Name and Position | Trudi Justice (PRESIDENT) |
| Authorized Official Contact | 5619279442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kmg Behavioral Health Services Llc 1601-1 N Main St Unit 3159 Jacksonville FL 32206-7707 Ph: (561) 927-9442 | Kmg Behavioral Health Services Llc 15165 Michelangelo Blvd Apt 207 Delray Beach FL 33446-6026 Ph: (561) 927-9442 |
| NPI Number | 1770297160 |
|---|---|
| Provider Enumeration Date | 01/10/2023 |
| Last Update Date | 10/26/2023 |
| Certification Date | 10/26/2023 |
| Medicare PECOS PAC ID | 1254782550 |
|---|---|
| Medicare Enrollment ID | O20240111001678 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770297160 | NPI | - | NPPES |
| Provider Name | Bartley D Gibson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699074682 PECOS PAC ID: 1355792557 Enrollment ID: I20240112000655 |
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