| Rising Tide Therapy, Llc | |
|
7647 W Gulf To Lake Hwy Ste 4 Crystal River FL 34429-7800 | |
| (352) 212-7435 | |
| Not Available |
| Full Name | Rising Tide Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 7647 W Gulf To Lake Hwy Ste 4, Crystal River, Florida |
| Authorized Official Name and Position | Laurie-anne C Kuzel (OWNER) |
| Authorized Official Contact | 3526341168 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rising Tide Therapy, Llc 7647 W Gulf To Lake Hwy Ste 4 Crystal River FL 34429-7800 Ph: (352) 212-7435 | Rising Tide Therapy, Llc 7647 W Gulf To Lake Hwy Ste 4 Crystal River FL 34429-7800 Ph: (352) 212-7435 |
| NPI Number | 1477209328 |
|---|---|
| Provider Enumeration Date | 03/01/2022 |
| Last Update Date | 03/01/2023 |
| Certification Date | 03/01/2023 |
| Medicare PECOS PAC ID | 2062852734 |
|---|---|
| Medicare Enrollment ID | O20240429000531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477209328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Laurie-anne C Kuzel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801270541 PECOS PAC ID: 8325488091 Enrollment ID: I20240429000786 |
| Provider Name | Sherri Marie Mkhwane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932449733 PECOS PAC ID: 1951742055 Enrollment ID: I20240507002181 |
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