Provider Demographics
NPI:1972218055
Name:EMERALD CLOVER, LLC
Entity Type:Organization
Organization Name:EMERALD CLOVER, LLC
Other - Org Name:ELLIE MENTAL HEALTH - ST. PETERSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:508-212-6095
Mailing Address - Street 1:324 N BAY HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4905
Mailing Address - Country:US
Mailing Address - Phone:717-608-0329
Mailing Address - Fax:
Practice Address - Street 1:9400 4TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2501
Practice Address - Country:US
Practice Address - Phone:727-513-2962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)