Healthcare Provider Details

I. General information

NPI: 1760980353
Provider Name (Legal Business Name): PAUL BROOKE HUGENS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SW CAMDEN AVE
STUART FL
34994-2924
US

IV. Provider business mailing address

1119 SW EAST LOUISE CIR
PORT ST LUCIE FL
34953-2805
US

V. Phone/Fax

Practice location:
  • Phone: 772-708-6933
  • Fax:
Mailing address:
  • Phone: 772-708-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: