Provider Demographics
NPI:1588838510
Name:CENTER FOR HUMAN POTENTIAL, P.A.
Entity Type:Organization
Organization Name:CENTER FOR HUMAN POTENTIAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-894-9777
Mailing Address - Street 1:5301 GULFPORT BLVD S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4947
Mailing Address - Country:US
Mailing Address - Phone:727-894-9777
Mailing Address - Fax:727-202-1010
Practice Address - Street 1:5301 GULFPORT BLVD S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4947
Practice Address - Country:US
Practice Address - Phone:727-894-9777
Practice Address - Fax:727-202-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010152OtherVALUE OPTIONS
FLGN551AMedicare PIN