Organization
LIFE MANAGEMENT CENTER OF NW FL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN R AILES LMFT (CEO/PRESIDENT)
(850) 522-4485
Entity
Organization
Contact information
Practice address
525 EAST 15TH STREET, PANAMA CITY, FL 32405-0000
(850) 522-4485
(850) 257-7967
Mailing address
525 E 15TH ST, PANAMA CITY, FL 32405-5412
(850) 522-4485
(850) 201-6024
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060296500
—
FL
01
—
99260
BLUE CROSS BLUE SHIELD
FL
Enumeration date
10/12/2005
Last updated
05/06/2026
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