Healthcare Provider Details

I. General information

NPI: 1639475528
Provider Name (Legal Business Name): MARSHA ELIGON L.M.H.C., C.A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SW 2ND CT
FT LAUDERDALE FL
33312-7134
US

IV. Provider business mailing address

21230 NE 9TH PL APT 2
NORTH MIAMI BEACH FL
33179-1288
US

V. Phone/Fax

Practice location:
  • Phone: 954-357-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9796
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: