=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104463173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LET'S TALK 4 HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2019
-----------------------------------------------------
Last Update Date | 12/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11622 NW 19TH DR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-5778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-856-4464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11622 NW 19TH DR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-5778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-856-4464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOTHERAPIST
-----------------------------------------------------
Name | MS. MICHELLE F ALBO
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 954-515-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------