Provider Demographics
NPI:1306993654
Name:SUNCOAST BEHAVIORAL MEDICINE, INC
Entity type:Organization
Organization Name:SUNCOAST BEHAVIORAL MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:941-926-2474
Mailing Address - Street 1:4370 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 241
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3412
Mailing Address - Country:US
Mailing Address - Phone:941-926-2474
Mailing Address - Fax:
Practice Address - Street 1:4370 S TAMIAMI TRL
Practice Address - Street 2:SUITE 241
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3412
Practice Address - Country:US
Practice Address - Phone:941-926-2474
Practice Address - Fax:941-926-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4720101YM0800X
FLPY 5729103T00000X
FLPT13914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9243Medicare ID - Type Unspecified