Healthcare Provider Details

I. General information

NPI: 1639617236
Provider Name (Legal Business Name): SOLID ROCK BEHAVIORAL HEALTH & ASSOCIATES, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 VILLA CIR
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

418 VILLA CIR
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 239-888-4501
  • Fax: 561-839-1535
Mailing address:
  • Phone: 239-888-4501
  • Fax: 561-839-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JOHANE LAPLANTE
Title or Position: COO
Credential:
Phone: 239-888-4501