Healthcare Provider Details

I. General information

NPI: 1295224822
Provider Name (Legal Business Name): PREMIER BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 PINES BLVD STE 300
PEMBROKE PINES FL
33027-1212
US

IV. Provider business mailing address

PO BOX 224392
CHRISTIANSTED VI
00822-4392
US

V. Phone/Fax

Practice location:
  • Phone: 340-227-2881
  • Fax:
Mailing address:
  • Phone: 340-227-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberPY8688
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DENESE MARSHALL
Title or Position: CEO
Credential: PSY.D.
Phone: 340-227-2881