| Life Management Center Of Northwest Florida Inc | |
|
4094 Lafayette St Marianna FL 32446-5648 | |
| (850) 522-4480 | |
| (850) 914-6281 |
| Full Name | Life Management Center Of Northwest Florida Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 4094 Lafayette St, Marianna, Florida |
| Authorized Official Name and Position | Edwin Ailes (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8505224480 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Management Center Of Northwest Florida Inc 525 E 15th St Panama City FL 32405-5412 Ph: (850) 522-4480 | Life Management Center Of Northwest Florida Inc 4094 Lafayette St Marianna FL 32446-5648 Ph: (850) 522-4480 |
| NPI Number | 1255367579 |
|---|---|
| Provider Enumeration Date | 06/26/2006 |
| Last Update Date | 03/29/2024 |
| Certification Date | 01/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255367579 | NPI | - | NPPES |
| 060296570 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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