Provider Demographics
NPI:1639339898
Name:TOUCHSTONE WELLNESS INSTITUTE LLC
Entity Type:Organization
Organization Name:TOUCHSTONE WELLNESS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BOTKIN
Authorized Official - Suffix:III
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-812-5321
Mailing Address - Street 1:2650 BAHIA VISTA ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2635
Mailing Address - Country:US
Mailing Address - Phone:941-812-5321
Mailing Address - Fax:
Practice Address - Street 1:2650 BAHIA VISTA ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2635
Practice Address - Country:US
Practice Address - Phone:941-812-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9485251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ167YOtherBLUE CROSS BLUE SHIELD OF FLORIDA