Healthcare Provider Details

I. General information

NPI: 1316701436
Provider Name (Legal Business Name): KCHM THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 06/02/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 GREENBRIAR PL
DAVIE FL
33325-6372
US

IV. Provider business mailing address

2114 N FLAMINGO RD # 2144
PEMBROKE PINES FL
33028-3501
US

V. Phone/Fax

Practice location:
  • Phone: 512-729-1634
  • Fax:
Mailing address:
  • Phone: 512-729-1634
  • 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

VIII. Authorized Official

Name: CHRISTINA PERSHAD POWELL
Title or Position: OWNER
Credential: LMHC-QS, LPC, PMH-C
Phone: 512-729-1634