Healthcare Provider Details

I. General information

NPI: 1326648098
Provider Name (Legal Business Name): A MENTAL QUEST, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 LAKE WORTH ROAD 320
GREENACRES FL
33467
US

IV. Provider business mailing address

6801 LAKE WORTH ROAD SUITE 320
GREENACRES FL
33467
US

V. Phone/Fax

Practice location:
  • Phone: 561-771-1306
  • Fax: 561-209-5940
Mailing address:
  • Phone: 561-771-1306
  • Fax: 561-209-5940

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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA BONET
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-771-1306