Healthcare Provider Details

I. General information

NPI: 1326428814
Provider Name (Legal Business Name): FENIX COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 PETERS RD SUITE 1000
PLANTATION FL
33324-3265
US

IV. Provider business mailing address

8201 PETERS RD SUITE 1000
PLANTATION FL
33324-3265
US

V. Phone/Fax

Practice location:
  • Phone: 954-916-2618
  • Fax:
Mailing address:
  • Phone: 954-916-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH7884
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMH7884
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberMH7884
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMH7884
License Number StateFL

VIII. Authorized Official

Name: CRISTOBAL J GONZALEZ
Title or Position: PRESIDENT
Credential: LMHC
Phone: 305-788-6553