Katrice Campbell
Individual provider Active NPI Case Manager/Care Coordinator · Bartow, FL
NPI 1780925784 · NPPES record last updated Aug 15, 2016
Key facts
- NPI
- 1780925784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- Practice address
- 1239 E Main St
Bartow, FL 33830-5058 - Phone
- (863) 519-0575
- NPI assigned
- Mar 15, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231124000359 | FL | Practitioner - Mental Health Counselor | 0749638146 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH14832 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cotler Healthcare & Development Inc. | Current |
Accepting new patients |
Locations
901 S 62nd Ave
Hollywood, FL 33023
Phone (954) 893-0109
9835 Lake Worth Rd
Ste 16179
Lake Worth, FL 33467
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH14832 | FL | |
| Case Manager/Care Coordinator | 171M00000X | Yes |
Addresses
Primary practice location
1239 E Main St
Bartow, FL 33830-5058
Mailing address
PO Box 1559
Bartow, FL 33831-1559
Other providers in Bartow, FL
- Sandra Burdine
- C.N.E Healthcare,LLC
- Jennifer Calandra
- Ricardo Caminante
- Jamie Campbell
- Kim Campbell
- Shandrea Campbell
- Rebecca K Campos
- Mary Frances Cannaday
- Melony Cardwell
All providers in Bartow, FL · Case Manager/Care Coordinator in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.