| Tidewater Total Mind Care, Llc | |
|
2650 Bahia Vista St Ste 204 Sarasota FL 34239-2625 | |
| (941) 202-1999 | |
| (941) 202-2009 |
| Full Name | Tidewater Total Mind Care, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2650 Bahia Vista St Ste 204, Sarasota, Florida |
| Authorized Official Name and Position | Steven Stein (PRACTICE OWNER) |
| Authorized Official Contact | 8132999439 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Total Mind Care, Llc 2650 Bahia Vista St Ste 204 Sarasota FL 34239-2625 Ph: (941) 202-1999 | Tidewater Total Mind Care, Llc 2650 Bahia Vista St Ste 204 Sarasota FL 34239-2625 Ph: (941) 202-1999 |
| NPI Number | 1457097032 |
|---|---|
| Provider Enumeration Date | 05/06/2022 |
| Last Update Date | 08/12/2024 |
| Certification Date | 08/12/2024 |
| Medicare PECOS PAC ID | 0648638734 |
|---|---|
| Medicare Enrollment ID | O20230622000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457097032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Steven M Stein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417319104 PECOS PAC ID: 4981936309 Enrollment ID: I20200817001347 |
| Provider Name | Christina Burge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861087058 PECOS PAC ID: 2860880812 Enrollment ID: I20211025003225 |
| Provider Name | Lee Erik Schlanger |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346866035 PECOS PAC ID: 0042660797 Enrollment ID: I20231221001909 |
| Provider Name | Justine J Jenkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154970713 PECOS PAC ID: 9638521487 Enrollment ID: I20240117004500 |
| Provider Name | Frances C Myers-routt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235205626 PECOS PAC ID: 5092249599 Enrollment ID: I20241106001797 |
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