Mid State Mental Health Assessment Inc | |
7052 Annunciation Circle Suite 329 Ave Maria FL 34142-0000 | |
(239) 352-4004 | |
Not Available |
Full Name | Mid State Mental Health Assessment Inc |
---|---|
Speciality | Psychologist |
Location | 7052 Annunciation Circle, Ave Maria, Florida |
Authorized Official Name and Position | Bruce Edward Malcolm (PRESIDENT) |
Authorized Official Contact | 2393524004 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Mid State Mental Health Assessment Inc 5819 Plymouth Pl Ave Maria FL 34142-9586 Ph: (239) 352-4004 | Mid State Mental Health Assessment Inc 7052 Annunciation Circle Suite 329 Ave Maria FL 34142-0000 Ph: (239) 352-4004 |
NPI Number | 1215262977 |
---|---|
Provider Enumeration Date | 10/13/2009 |
Last Update Date | 02/06/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215262977 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | PY8461 (Florida) | Primary |
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