| Map | |
|
1219 Millennium Pkwy Ste 116 Brandon FL 33511-3891 | |
| (813) 455-8672 | |
| Not Available |
| Full Name | Map |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1219 Millennium Pkwy Ste 116, Brandon, Florida |
| Authorized Official Name and Position | Shawn Marie North (OWNER/MANAGING MEMBER) |
| Authorized Official Contact | 8134558672 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Map 1305 Rustling Oaks Dr Brandon FL 33510-2358 Ph: (813) 455-8672 | Map 1219 Millennium Pkwy Ste 116 Brandon FL 33511-3891 Ph: (813) 455-8672 |
| NPI Number | 1770149072 |
|---|---|
| Provider Enumeration Date | 05/13/2019 |
| Last Update Date | 06/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770149072 | NPI | - | NPPES |
| 020425900 | Medicaid | FL |
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