Healthcare Provider Details

I. General information

NPI: 1881005239
Provider Name (Legal Business Name): MARTY SEYLER LMHC CFLE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PALM BEACH LAKES BLVD STE 502G
WEST PALM BEACH FL
33409-6510
US

IV. Provider business mailing address

2001 PALM BEACH LAKES BLVD STE 502G
WEST PALM BEACH FL
33409-6510
US

V. Phone/Fax

Practice location:
  • Phone: 561-596-2136
  • Fax:
Mailing address:
  • Phone: 561-596-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 4863
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name: MARTHA ANN SEYLER
Title or Position: DIRECTOR
Credential: LMHC
Phone: 561-596-2136