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General NPI Number Information
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NPI Number | 1083865117
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH SERVICES LCSW LLC
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 1415 PANTHER LN UNIT 142
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City | NAPLES
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State | FL
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Zip | 34109-7874
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Country | US
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Telephone | 239-810-3998
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Fax | 239-236-1215
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Provider Business Mailing Address
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Address Line | 16520 S TAMIAMI TRL UNIT 138 PMB 187
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City | FORT MYERS
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State | FL
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Zip | 33908-4569
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Country | US
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Telephone | 239-810-3998
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Fax | 239-236-1215
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Authorized Official
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Title or Position | MANAGER
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Name | KATHY A FRATRICK
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Credential | LCSW
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Telephone | 239-810-3998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW5602
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License Number State | FL
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