| Lbm Pmhnp | |
|
109 Ceja Way St Augustine FL 32095-4852 | |
| (402) 813-3716 | |
| Not Available |
| Full Name | Lbm Pmhnp |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 109 Ceja Way, St Augustine, Florida |
| Authorized Official Name and Position | Latishsa Blanchard (PRESIDENT) |
| Authorized Official Contact | 4028133716 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lbm Pmhnp 109 Ceja Way St Augustine FL 32095-4852 Ph: (402) 813-3716 | Lbm Pmhnp 109 Ceja Way St Augustine FL 32095-4852 Ph: (402) 813-3716 |
| NPI Number | 1346825015 |
|---|---|
| Provider Enumeration Date | 03/15/2021 |
| Last Update Date | 03/15/2021 |
| Certification Date | 03/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346825015 | NPI | - | NPPES |
| B452-533-77-542-0 | Other | FL | FL DRIVERS LICENSE |
| B452-533-77-542-0 | Other | FL | DRIVERS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
Mary Alston Kerllenevich, Ph.d. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1100 S Ponce De Leon Blvd Ste 1, St Augustine, FL 32084 Phone: 904-824-7733 Fax: 904-829-9768 | |
Mcgreevy Neurohealth Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 559 W Twincourt Trl, #607, St Augustine, FL 32095 Phone: 904-230-3006 | |
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Logan Sincavage, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 143 Old Field Ln, St Augustine, FL 32092 Phone: 561-309-4219 | |
Cornerstone Christian Counseling, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 320 Paseo Reyes Dr, St Augustine, FL 32095 Phone: 904-439-4400 Fax: 303-484-3943 | |
J Greg Dent M D & Associates P L Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Health Park Blvd, St Augustine, FL 32086 Phone: 904-819-4565 Fax: 904-819-4999 | |
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