Healthcare Provider Details

I. General information

NPI: 1164535092
Provider Name (Legal Business Name): TRINITY HARBOR THERAPEUTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 WILES RD SUITE 150
CORAL SPRINGS FL
33067-2036
US

IV. Provider business mailing address

7401 WILES RD SUITE 150
CORAL SPRINGS FL
33067-2036
US

V. Phone/Fax

Practice location:
  • Phone: 954-341-7774
  • Fax: 480-287-9456
Mailing address:
  • Phone: 954-341-7774
  • Fax: 480-287-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberSW8335
License Number StateFL

VIII. Authorized Official

Name: MRS. SHAWN MICHELLE GORDON
Title or Position: CLINICAL THERAPIST
Credential: LCSW
Phone: 954-341-7774