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PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC NPI 1104572551


NPI Information

NPI: 1104572551
Provider Name: PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC

Doing Business As: PEACE RIVER CENTER

Classification: Psychiatry & Neurology - 2084P0800X
Entity Type: Organization

Specialization: Psychiatry

Address:
1255 GOLFVIEW AVE
BARTOW, FL
ZIP 33830
Phone: (863) 519-0575
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PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC is a psychiatry psychiatry neurology in Bartow, FL. The provider is a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC NPI is 1104572551. The provider is registered as an organization entity type.
The provider Is Doing Business As Peace River Center.

The provider's business location address is:

1255 GOLFVIEW AVE
BARTOW, FL
ZIP 33830-736
Phone: (863) 519-0575
Fax: (863) 582-9251

The provider's authorized official is Jo Deck .
The authorized official title is Credentialing Specialist and has the following contact phone number (863) 519-0575.

The enumeration date for this NPI number is 2/24/2022 and was last updated on 2/1/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
22084P0800XPsychiatry & NeurologyPsychiatryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1060310438MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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