NPIMap

Organization Active NPI

Life Management Center of Northwest Florida Inc.

  • Counselor
  • Panama City, FL
National Provider Identifier
1942235320
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA INC.
Practice address
525 E 15TH St
Panama City, FL 32405-5412
Phone
(850) 522-4480
Fax
(850) 914-6281
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

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

Authorized official

Name
Edwin Ailes
Title
Executive Director
Phone
(850) 522-4485

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X Primary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

525 E 15TH St
Panama City, FL 32405-5412

Mailing address

525 E 15TH St
Panama City, FL 32405-5412
Phone (850) 522-4480

Other identifiers 1

IdentifierTypeStateIssuer
060296528MedicaidFL

Other names 1

  • Life Management Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Life Management Ctr of3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711670400000",
    "number": "1942235320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E 15TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324055412",
            "telephone_number": "850-522-4480",
            "fax_number": "850-914-6281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 15TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324055412",
            "telephone_number": "850-522-4480",
            "fax_number": "850-914-6281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A",
        "authorized_official_last_name": "AILES",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-522-4485"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060296528",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Management Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; 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.