Provider Demographics
NPI:1760460653
Name:CHARLOTTE BEHAVIORAL HEALTH CARE INC
Entity Type:Organization
Organization Name:CHARLOTTE BEHAVIORAL HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-639-8300
Mailing Address - Street 1:1700 EDUCATION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6222
Mailing Address - Country:US
Mailing Address - Phone:941-639-8300
Mailing Address - Fax:941-639-6831
Practice Address - Street 1:1700 EDUCATION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6222
Practice Address - Country:US
Practice Address - Phone:941-639-8300
Practice Address - Fax:941-639-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0808AD492200101YA0400X, 101YM0800X, 1041C0700X
FL1477251S00000X
FL2008AD4922-00-P324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141305800Medicaid
FL97564OtherBLUE CROSS
FL060480100Medicaid
FL060480100Medicaid