Healthcare Provider Details

I. General information

NPI: 1891237376
Provider Name (Legal Business Name): CHAD KOLLER MS,CAP, ICADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 FAU BOULVARD INNOVATION CENTER 2, SUITE 200
BOCA RATON FL
33431
US

IV. Provider business mailing address

4242 PINE CONE LN
BOYNTON BEACH FL
33436
US

V. Phone/Fax

Practice location:
  • Phone: 561-251-7263
  • Fax:
Mailing address:
  • Phone: 561-251-7263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: