Healthcare Provider Details

I. General information

NPI: 1063340321
Provider Name (Legal Business Name): TEMPLE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 POLK ST UNIT 220342
HOLLYWOOD FL
33022-5018
US

IV. Provider business mailing address

1801 POLK ST UNIT 220342
HOLLYWOOD FL
33022-5018
US

V. Phone/Fax

Practice location:
  • Phone: 954-228-0794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMECCA NEELY
Title or Position: OWNER
Credential:
Phone: 954-228-0794