| Legacy Behavioral Health Center | |
|
518 Sw Prima Vista Blvd Port St Lucie FL 34983-8734 | |
| (772) 873-8811 | |
| (772) 873-8800 |
| Full Name | Legacy Behavioral Health Center |
|---|---|
| Speciality | Behavior Analyst |
| Location | 518 Sw Prima Vista Blvd, Port St Lucie, Florida |
| Authorized Official Name and Position | Ivan Rafael Jimenez (HR DIRECTOR) |
| Authorized Official Contact | 5612531770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Behavioral Health Center 518 Sw Prima Vista Blvd Port St Lucie FL 34983-8734 Ph: (772) 873-8811 | Legacy Behavioral Health Center 518 Sw Prima Vista Blvd Port St Lucie FL 34983-8734 Ph: (772) 873-8811 |
| NPI Number | 1659193357 |
|---|---|
| Provider Enumeration Date | 10/25/2024 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659193357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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