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21903 Panama City Beach Pkwy Panama City Beach FL 32413-3219 | |
| (850) 588-7089 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 21903 Panama City Beach Pkwy, Panama City Beach, Florida |
| Authorized Official Name and Position | Leticia Freeland Grove (COUNSELOR) |
| Authorized Official Contact | 8502911344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
21903 Panama City Beach Pkwy Panama City Beach FL 32413-3219 Ph: (850) 588-7089 | 21903 Panama City Beach Pkwy Panama City Beach FL 32413-3219 Ph: (850) 588-7089 |
| NPI Number | 1295079416 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 02/04/2016 |
| Medicare PECOS PAC ID | 6608300280 |
|---|---|
| Medicare Enrollment ID | O20241106000617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295079416 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH9752 (Florida) | Primary |
| Provider Name | Leticia Freeland Grove |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063647618 PECOS PAC ID: 3971627522 Enrollment ID: I20241106000798 |
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