Healthcare Provider Details

I. General information

NPI: 1649715335
Provider Name (Legal Business Name): THE CAVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 PORTOFINO WAY 207
WEST PALM BEACH FL
33409-8154
US

IV. Provider business mailing address

PO BOX 223586
WEST PALM BEACH FL
33422-3586
US

V. Phone/Fax

Practice location:
  • Phone: 561-557-2741
  • Fax: 561-469-2447
Mailing address:
  • Phone: 561-557-2741
  • Fax: 561-469-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TD MCNUTT
Title or Position: FOUNDER/VISIONARY
Credential: DR.
Phone: 561-557-2741