Healthcare Provider Details

I. General information

NPI: 1669707204
Provider Name (Legal Business Name): KATIE SKOPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 RCA BLVD STE 105
PALM BEACH GARDENS FL
33410-3335
US

IV. Provider business mailing address

2560 RCA BLVD STE 105
PALM BEACH GARDENS FL
33410-3335
US

V. Phone/Fax

Practice location:
  • Phone: 954-729-7477
  • Fax: 561-799-5000
Mailing address:
  • Phone: 954-729-7477
  • Fax: 561-799-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW6411
License Number StateFL

VIII. Authorized Official

Name: KATIE R SKOPP
Title or Position: OWNER
Credential: MSW
Phone: 954-796-7477