Chautauqua Offices of Psychotherapy and Evaluation, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

0166AD9145-01 Issued in FL

Legal business name

CHAUTAUQUA OFFICES OF PSYCHOTHERAPY AND EVALUATION, INC.

Practice address

3686 US Highway 331 S
Defuniak Springs, FL 32435-8463

Phone

(850) 892-8045

Fax

(850) 892-8039

NPI assigned

Oct 3, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rachel R Gillis, LCSW BCD

Title

Chief Executive Officer

Phone

(850) 892-8045

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• C.O.P.E. Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1801883160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3686 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324358463",
            "telephone_number": "850-892-8045",
            "fax_number": "850-892-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3686 US HIGHWAY 331 S",
            "city": "DEFUNIAK SPRINGS",
            "state": "FL",
            "postal_code": "324358463",
            "telephone_number": "850-892-8045",
            "fax_number": "850-892-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAUTAUQUA OFFICES OF PSYCHOTHERAPY AND EVALUATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "GILLIS",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "850-892-8045",
        "authorized_official_credential": "LCSW BCD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "0166AD9145-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060369400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "77467",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "C.O.P.E. Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James Wesley Cantrell, RPH
• Christina Faye Carnley, BCBA
• Daniel Carnley
• Alfredo Cartaya, MD
• Centanni Enterprises Inc
• Chautauqua Springs Health Center LLC
• Chuck Stevenson OD PA
• Cari B Cole, PHARMD
• Kellyanne Evans Collins
• Rachel Kyleen Collinsworth, RBT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Defuniak Springs, FL
• Providers in Defuniak Springs, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.