Provider Demographics
NPI:1245513274
Name:PERSONAL ENRICHMENT THROUGH MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:PERSONAL ENRICHMENT THROUGH MENTAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:WENNLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MBA
Authorized Official - Phone:727-545-6477
Mailing Address - Street 1:11254 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2213
Mailing Address - Country:US
Mailing Address - Phone:727-545-6477
Mailing Address - Fax:727-545-6464
Practice Address - Street 1:1614 PALM WAY
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3926
Practice Address - Country:US
Practice Address - Phone:727-545-6477
Practice Address - Fax:727-507-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management