| Ljak Enterprises Llc | |
|
8354 N Davis Hwy Suite 200 Pensacola FL 32514 | |
| (850) 516-5592 | |
| Not Available |
| Full Name | Ljak Enterprises Llc |
|---|---|
| Speciality | Counselor |
| Location | 8354 N Davis Hwy, Pensacola, Florida |
| Authorized Official Name and Position | Ronald Kennedy (OWNER) |
| Authorized Official Contact | 8505165592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ljak Enterprises Llc 5629 Preakness Ct Pace FL 32571-6378 Ph: (850) 516-5592 | Ljak Enterprises Llc 8354 N Davis Hwy Suite 200 Pensacola FL 32514 Ph: (850) 516-5592 |
| NPI Number | 1942992029 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 05/25/2023 |
| Certification Date | 05/16/2023 |
| Medicare PECOS PAC ID | 3971042938 |
|---|---|
| Medicare Enrollment ID | O20240822002456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942992029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Nicole K Bowman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487038220 PECOS PAC ID: 0042578049 Enrollment ID: I20171221000088 |
| Provider Name | Jeffrey Lewis Ray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659516805 PECOS PAC ID: 8426597493 Enrollment ID: I20240822002889 |
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