Healthcare Provider Details

I. General information

NPI: 1285495879
Provider Name (Legal Business Name): PIVOT PERSPECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SW 18TH AVE
FORT LAUDERDALE FL
33312-1525
US

IV. Provider business mailing address

217 SW 18TH AVE
FORT LAUDERDALE FL
33312-1525
US

V. Phone/Fax

Practice location:
  • Phone: 315-767-1432
  • Fax:
Mailing address:
  • Phone: 315-767-1432
  • 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: MEGAN POTTER
Title or Position: OWNER/COUNSELOR
Credential:
Phone: 315-767-1432