Healthcare Provider Details

I. General information

NPI: 1982140471
Provider Name (Legal Business Name): MARCIA GONCALVES TERLEP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 S CONGRESS AVE STE 1F
PALM SPRINGS FL
33406-7667
US

IV. Provider business mailing address

1354 WILLOW RD
WEST PALM BEACH FL
33406-5066
US

V. Phone/Fax

Practice location:
  • Phone: 561-308-8191
  • Fax: 561-439-3707
Mailing address:
  • Phone: 561-308-8191
  • Fax: 561-439-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 12284
License Number StateFL

VIII. Authorized Official

Name: MRS. MARCIA A. GONCALVES -TERLEP
Title or Position: OWNER
Credential: M.A.
Phone: 561-308-8191