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8359 Beacon Blvd Ste 514 Fort Myers FL 33907-3066 | |
| (239) 940-7025 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 8359 Beacon Blvd Ste 514, Fort Myers, Florida |
| Authorized Official Name and Position | Vicki Lynne Bonham (DIRECTOR) |
| Authorized Official Contact | 2399407025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8359 Beacon Blvd Ste 514 Fort Myers FL 33907-3066 Ph: (239) 940-7025 | 8359 Beacon Blvd Ste 514 Fort Myers FL 33907-3066 Ph: (239) 940-7025 |
| NPI Number | 1891537668 |
|---|---|
| Provider Enumeration Date | 06/11/2024 |
| Last Update Date | 07/09/2024 |
| Certification Date | 07/09/2024 |
| Medicare PECOS PAC ID | 0547709966 |
|---|---|
| Medicare Enrollment ID | O20240829002800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891537668 | NPI | - | NPPES |
| Provider Name | Vicki Lynne Bonham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881316776 PECOS PAC ID: 0941645063 Enrollment ID: I20240228004012 |
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