Healthcare Provider Details

I. General information

NPI: 1780246470
Provider Name (Legal Business Name): PALM BEACH CENTER FOR CHILD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD STE 208
COCONUT CREEK FL
33073-4397
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD STE 208
COCONUT CREEK FL
33073-4397
US

V. Phone/Fax

Practice location:
  • Phone: 443-299-8908
  • Fax:
Mailing address:
  • Phone: 443-299-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MORGAN MOTES
Title or Position: PRESIDENT
Credential:
Phone: 443-299-8908