Healthcare Provider Details

I. General information

NPI: 1649744285
Provider Name (Legal Business Name): SHALOM YACHNES LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 CAMINO REAL STE 404
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

7100 CAMINO REAL STE 404
BOCA RATON FL
33433-5510
US

V. Phone/Fax

Practice location:
  • Phone: 404-509-7637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: