Provider Demographics
NPI:1013738996
Name:HARMONY BY THE SEA: MENTAL HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:HARMONY BY THE SEA: MENTAL HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-615-0879
Mailing Address - Street 1:422 WHISPERING CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-3129
Mailing Address - Country:US
Mailing Address - Phone:352-615-0879
Mailing Address - Fax:
Practice Address - Street 1:4476 LEGENDARY DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5375
Practice Address - Country:US
Practice Address - Phone:352-615-0879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770022378Medicaid