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General NPI Number Information
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NPI Number | 1134014111
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Entity Type | Organization
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Legal Business Name | FUTURE STARS BEHAVIORAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1876 BAYTHORNE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-6306
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Country | US
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Telephone | 305-790-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 1876 BAYTHORNE RD
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-6306
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Country | US
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Telephone | 561-758-6152
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISSETTE COLLAZO MAZA
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Credential | LCSW
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Telephone | 561-758-6152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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