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3527 Tamiami Trl Ste E Port Charlotte FL 33952-8128 | |
| (910) 319-8874 | |
| (239) 932-7252 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3527 Tamiami Trl Ste E, Port Charlotte, Florida |
| Authorized Official Name and Position | Tarra Farnham (OWNER) |
| Authorized Official Contact | 9108499762 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1825 Tamiami Trl Ste J-1005 Port Charlotte FL 33948-1077 Ph: () - | 3527 Tamiami Trl Ste E Port Charlotte FL 33952-8128 Ph: (910) 319-8874 |
| NPI Number | 1770077810 |
|---|---|
| Provider Enumeration Date | 06/21/2018 |
| Last Update Date | 04/13/2022 |
| Certification Date | 04/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770077810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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