Healthcare Provider Details

I. General information

NPI: 1205455672
Provider Name (Legal Business Name): SOUTH FLORIDA MENTAL HEALTH SOLUTIONS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 SE 1ST AVE
FORT LAUDERDALE FL
33316-2875
US

IV. Provider business mailing address

1848 SE 1ST AVE
FORT LAUDERDALE FL
33316-2875
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-9500
  • Fax: 954-885-9444
Mailing address:
  • Phone: 954-885-9500
  • Fax: 954-885-9444

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JOHN TAR
Title or Position: PRESIDENT
Credential:
Phone: 954-885-9500