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207 Cross St Suite 103 Punta Gorda FL 33950-4432 | |
| (941) 916-5291 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 207 Cross St, Punta Gorda, Florida |
| Authorized Official Name and Position | Amanda Mcdonald Kennard (CEO) |
| Authorized Official Contact | 9419165291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 7020 North Port FL 34290-0020 Ph: (941) 916-5291 | 207 Cross St Suite 103 Punta Gorda FL 33950-4432 Ph: (941) 916-5291 |
| NPI Number | 1093171787 |
|---|---|
| Provider Enumeration Date | 01/11/2016 |
| Last Update Date | 01/11/2016 |
| Medicare PECOS PAC ID | 3779949847 |
|---|---|
| Medicare Enrollment ID | O20240111001037 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093171787 | NPI | - | NPPES |
| 003976200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH9262 (Florida) | Primary |
| Provider Name | Amanda Mcdonald Kennard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275719171 PECOS PAC ID: 0143686212 Enrollment ID: I20240111001088 |
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