| Organization Name: | JOURNEYPURE PANHANDLE MEDICAL GROUP LLC |
| NPI Number: | 1033567268 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN D LEE (CEO) |
| Mailing Address: | 22219 Panama City Beach Pkwy Panama City |
| State: | FL US |
| Postal Code: | 324133227 |
| Phone Number: | 8502494300 |
| Fax Number: | |
| NPI Enumeration Date: | 05/27/2016 |
| NPI Last Update Date: | 05/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 59359 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |