Healthcare Provider Details

I. General information

NPI: 1437519055
Provider Name (Legal Business Name): EBH SERVICES OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N OAK ST SUITE 109
LANTANA FL
33462-3260
US

IV. Provider business mailing address

PO BOX 670521
DALLAS TX
75267-0521
US

V. Phone/Fax

Practice location:
  • Phone: 561-337-2600
  • Fax:
Mailing address:
  • Phone: 615-567-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME110917
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP1688752
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP3156662
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberRN9366620
License Number StateFL

VIII. Authorized Official

Name: CHERYL MAPLESDEN
Title or Position: DIRECTOR, REVENUE CYCLE
Credential: CPC, CHC, CHPC
Phone: 615-510-3708