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General NPI Number Information
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NPI Number | 1114136991
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY & NUTRITION ASSOC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 5820 N FEDERAL HWY SUITE A2
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City | BOCA RATON
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State | FL
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Zip | 33487-4003
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Country | US
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Telephone | 561-602-0132
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Fax | 561-353-0699
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Provider Business Mailing Address
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Address Line | 5820 N FEDERAL HWY SUITE A2
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City | BOCA RATON
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State | FL
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Zip | 33487-4003
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Country | US
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Telephone | 561-602-0132
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Fax | 561-353-0699
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PAMELA J GARBER
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Credential | LMHC
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Telephone | 561-602-0132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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