Healthcare Provider Details

I. General information

NPI: 1679714653
Provider Name (Legal Business Name): ANNAPURNA INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 COMMERCE CENTER DR STE A
SEBASTIAN FL
32958-3136
US

IV. Provider business mailing address

PO BOX 1021
ROSELAND FL
32957-1021
US

V. Phone/Fax

Practice location:
  • Phone: 772-589-4488
  • Fax: 772-589-9027
Mailing address:
  • Phone: 772-589-4886
  • Fax: 772-589-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH1720
License Number StateFL

VIII. Authorized Official

Name: ANDREAS S BRAUN
Title or Position: OWNER
Credential: LMHC, PHD
Phone: 772-589-4886