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NPI Code Detail

MEDICARE: CHRISTIAN BEHAVIORAL HEALTH SPECIALISTS

MEDICARE: CHRISTIAN BEHAVIORAL HEALTH SPECIALISTS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
22084P0800XPsychiatry Physician
3364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
4363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1568793982
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRISTIAN BEHAVIORAL HEALTH SPECIALISTS
Provider Business Mailing Address
First Line : 600 SW 3RD ST
Second Line : SUITE 2270
City : POMPANO BEACH
State : FL
Zip : 33060-6932
Country : US
Telephone Number : 954-962-9090
Fax Number : 954-962-9594
Provider Business Practice Location Address
First Line : 600 SW 3RD ST
Second Line : SUITE 2270
City : POMPANO BEACH
State : FL
Zip : 33060-6932
Country : US
Telephone Number : 954-962-9090
Fax Number : 954-962-9594
Authorized Official
Title or Position : PRESIDENT
Name : MS. DENISE A CANCHOLA
Credential : ARNP
Telephone Number : 954-962-9090
Provider Enumeration Date : 01/25/2010
Last Update Date : 01/25/2010

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