Healthcare Provider Details

I. General information

NPI: 1093307720
Provider Name (Legal Business Name): BOUT ME HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9858 CLINT MOORE RD STE C111-202
BOCA RATON FL
33496-1034
US

IV. Provider business mailing address

9858 CLINT MOORE RD STE C111-202
BOCA RATON FL
33496-1034
US

V. Phone/Fax

Practice location:
  • Phone: 786-472-0220
  • Fax:
Mailing address:
  • Phone: 786-472-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: C RIVERA GONZALEZ
Title or Position: CEO
Credential: CAP
Phone: 786-472-0220