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2100 Constitution Blvd Sarasota FL 34231-4146 | |
| (941) 780-6939 | |
| (941) 953-1399 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2100 Constitution Blvd, Sarasota, Florida |
| Authorized Official Name and Position | Richard Harbeson Nikla (OWNER) |
| Authorized Official Contact | 9417806939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5441 Riverbluff Cir # V85 Sarasota FL 34231-5025 Ph: (941) 780-6939 | 2100 Constitution Blvd Sarasota FL 34231-4146 Ph: (941) 780-6939 |
| NPI Number | 1225418155 |
|---|---|
| Provider Enumeration Date | 06/05/2015 |
| Last Update Date | 01/11/2024 |
| Certification Date | 01/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225418155 | NPI | - | NPPES |
| 003673000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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