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General NPI Number Information
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NPI Number | 1154592970
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Entity Type | Organization
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Legal Business Name | FORT LAUDERDALE COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 915 MIDDLE RIVER DR SUITE 204
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3559
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Country | US
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Telephone | 954-763-6557
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Fax | 954-561-8331
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Provider Business Mailing Address
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Address Line | 915 MIDDLE RIVER DR SUITE 204
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3559
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Country | US
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Telephone | 954-763-6557
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Fax | 954-561-8331
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH W BLAKE
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Credential | PHD
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Telephone | 954-763-6557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY4139
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License Number State | FL
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