| Lucidity Wellness Group Llc | |
|
803 Jenks Ave Ste 1a Panama City FL 32401 | |
| (850) 215-4060 | |
| (850) 481-1578 |
| Full Name | Lucidity Wellness Group Llc |
|---|---|
| Speciality | General Practice |
| Location | 803 Jenks Ave, Panama City, Florida |
| Authorized Official Name and Position | Lisa Marie Harris (OWNER/PRACTICE MANAGER) |
| Authorized Official Contact | 8502154060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lucidity Wellness Group Llc 803 Jenks Ave Ste 1a Panama City FL 32401 Ph: (850) 215-4060 | Lucidity Wellness Group Llc 803 Jenks Ave Ste 1a Panama City FL 32401 Ph: (850) 215-4060 |
| NPI Number | 1194590018 |
|---|---|
| Provider Enumeration Date | 11/21/2023 |
| Last Update Date | 11/21/2023 |
| Certification Date | 11/21/2023 |
| Medicare PECOS PAC ID | 9638518541 |
|---|---|
| Medicare Enrollment ID | O20240411002022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194590018 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Michael Forehand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730133521 PECOS PAC ID: 4183627391 Enrollment ID: I20060808000429 |
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