Provider Demographics
NPI:1699029017
Name:SUNCOAST MENTAL HELATH
Entity Type:Organization
Organization Name:SUNCOAST MENTAL HELATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-679-6334
Mailing Address - Street 1:2814 S US HIGHWAY 1 STE D4
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8110
Mailing Address - Country:US
Mailing Address - Phone:718-679-6334
Mailing Address - Fax:772-489-0423
Practice Address - Street 1:2814 SOUTH U.S HIGHWAY 1, SUITE D4
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982
Practice Address - Country:US
Practice Address - Phone:718-679-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNCOAST MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health