Mid State Mental Health Assessment INC

NPI #1215262977 in Ave Maria, Florida

Provider Information

NPI Number: 1215262977
Entity Type: Organization
Organization Name: Mid State Mental Health Assessment INC
Primary Specialty: Psychologist
Enumeration Date: Oct 13, 2009
Last Updated: Feb 6, 2013

Practice Location

Address: 7052 ANNUNCIATION CIRCLE
Address 2: SUITE 329
City: Ave Maria
State: Florida
ZIP Code: 34142-0000
Phone: (239) 352-4004

Authorized Official

Name: DR. BRUCE EDWARD MALCOLM, PSY.D.
Title: PRESIDENT
Phone: (239) 352-4004

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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