Organization
PEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JO DECK BA, CPC (CREDENTIALING SPECIALIST)
(863) 519-0575
Entity
Organization
Contact information
Practice address
1825 GILMORE AVE, LAKELAND, FL 33805-3017
(863) 519-0575
(863) 582-9251
Mailing address
PO BOX 1559, BARTOW, FL 33831-1559
(863) 519-0575
(863) 582-9251
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060310439
—
FL
Enumeration date
04/14/2022
Last updated
02/01/2023
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