Healthcare Provider Details

I. General information

NPI: 1013527431
Provider Name (Legal Business Name): BE FREE STAY FREE FAMILY & INDIVIDUAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2020
Last Update Date: 08/01/2020
Certification Date: 08/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 WHITEHALL DR APT 206
WEST PALM BEACH FL
33401-1065
US

IV. Provider business mailing address

640 CLEMATIS ST UNIT 2474
WEST PALM BEACH FL
33402-5104
US

V. Phone/Fax

Practice location:
  • Phone: 561-377-2373
  • Fax:
Mailing address:
  • Phone: 561-377-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. PATRICIA ELDER
Title or Position: CEO
Credential: LMFT, LMHC
Phone: 561-377-2373