Healthcare Provider Details

I. General information

NPI: 1710789862
Provider Name (Legal Business Name): MY VIRTUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 N MILITARY TRL APT 472
BOCA RATON FL
33496-3571
US

IV. Provider business mailing address

5500 N MILITARY TRL APT 472
BOCA RATON FL
33496-3571
US

V. Phone/Fax

Practice location:
  • Phone: 954-536-4666
  • Fax:
Mailing address:
  • Phone: 954-536-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WILSON
Title or Position: CEO
Credential:
Phone: 954-536-4666