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107 Ben Hill Griffin Rd Venus FL 33960-2025 | |
| (470) 243-0402 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 Ben Hill Griffin Rd, Venus, Florida |
| Authorized Official Name and Position | Jaime L Mckenzie (OWNER) |
| Authorized Official Contact | 7722004619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
107 Ben Hill Griffin Rd Venus FL 33960-2025 Ph: () - | 107 Ben Hill Griffin Rd Venus FL 33960-2025 Ph: (470) 243-0402 |
| NPI Number | 1043041999 |
|---|---|
| Provider Enumeration Date | 08/12/2024 |
| Last Update Date | 09/14/2024 |
| Certification Date | 09/14/2024 |
| Medicare PECOS PAC ID | 3375074735 |
|---|---|
| Medicare Enrollment ID | O20241009002464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043041999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jaime L Mckenzie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801198676 PECOS PAC ID: 5193256550 Enrollment ID: I20241009003194 |