EMERALD COAST WELLNESS CENTER, LLC (NPI# 1417287855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417287855 |
| Entity Type | Organization |
| Organization Name | EMERALD COAST WELLNESS CENTER, LLC |
| Practice Address |
138 Baywind Dr Niceville FL 32578-4800 |
| Practice Telephone | 8503984155 |
| Practice Fax Number | 8503984142 |
| Mailing Telephone | 8503984155 |
| Mailing Fax Number | 8503984142 |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2015-09-02 |
| Authorized Official Name | DR. HENRY ALEXANDER BOILINI (PSYCHIATRIST) |
| Authorized Official Telephone | 8505435678 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 008056800 | 05 |
| Street Address |
138 BAYWIND DR |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578-4800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028563 | Southern Breeze Healthcare | Family Medicine | 4556 E Hwy 20, Suite 105, Niceville, FL 32578 | 2018-10-03 |
| 1497252860 | Molly Marie Everitt | Physician Assistant | 2190 Fl-85 N, Niceville, FL 32578 | 2018-04-11 |
| 1972009314 | Alexis Aust | Student in an Organized Health Care Education/Training Program | 104 Arrowhead Way, Niceville, FL 32578 | 2018-04-04 |
| 1518488949 | Michelle Sasala | Nurse Practitioner | 4550 E Highway 20, Niceville, FL 32578 | 2017-07-06 |
| 1003336199 | Comfortable Care Denta Health Professionals, Pa | Dentist | 1386 E John Sims Parkway, Niceville, FL 32578 | 2017-06-21 |
| 1306223888 | Emerald Coast Periodontics | Dentist | 719 Bayshore Drive, Niceville, FL 32578 | 2015-05-04 |
| 1538586136 | Pamela Ottesen Dmd LLC | Dentist | 1536 John Sims Pkwy, Niceville, FL 32578 | 2014-03-21 |
| 1417204066 | Mary Jo Stiles | Hearing Instrument Specialist | 4400 Hwy, 20 East, Suite # 211, Niceville, FL 32578 | 2012-08-13 |
| 1093086563 | Pat T. Tidwell Md Pa | Clinic/Center | 4554 Highway 20 East, Niceville, FL 32578 | 2012-01-16 |
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| Find all providers in zip 32578 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326646654 | Movimentum Psychology | Clinic/Center | 1317 Edgewater Dr Unit 902, Orlando, FL 32804-6350 | 2020-10-09 |
| 1619584802 | U Matter Behavior Therapy LLC | Clinic/Center | 12360 Sw 132nd Ct Ste 108b, Miami, FL 33186-6461 | 2020-09-30 |
| 1508472648 | Illume Counseling & Play Therapy | Clinic/Center | 35008 Emerald Coast Pkwy Ste 203, Destin, FL 32541-4752 | 2020-09-22 |
| 1285240960 | Telepsych LLC | Clinic/Center | 15 Paradise Plz Ste 270, Sarasota, FL 34239-6905 | 2020-09-18 |
| 1790398030 | Olympic Behavioral Health LLC. | Clinic/Center | 3200 S Congress Ave Ste 101, Boynton Beach, FL 33426-9041 | 2020-08-26 |
| 1184237737 | Adel's Hope LLC | Clinic/Center | 160 Island Beach Blvd, Merritt Is, FL 32952-5016 | 2020-08-24 |
| 1790397479 | Eloy Franco Md LLC | Clinic/Center | 7320 E Fletcher Ave Ste 108, Tampa, FL 33637-0916 | 2020-08-23 |
| 1710597208 | Challenges Conquered Counseling and Consulting, LLC | Clinic/Center | 242 Commercial Blvd Ste C, Lauderdale By The Sea, FL 33308-4496 | 2020-08-09 |
| 1134738990 | Trauma and Transition Services LLC | Clinic/Center | 360 Central Ave Ste 800, St Petersburg, FL 33701-3984 | 2020-07-28 |
| 1629687520 | Frontline Recovery Center, Inc | Clinic/Center | 6503 Sw 19th St, North Lauderdale, FL 33068-4808 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EMERALD COAST WELLNESS CENTER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.