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General NPI Number Information
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NPI Number | 1164535092
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Entity Type | Organization
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Legal Business Name | TRINITY HARBOR THERAPEUTIC SERVICES, INC.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 7401 WILES RD SUITE 150
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2036
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Country | US
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Telephone | 954-341-7774
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Fax | 480-287-9456
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Provider Business Mailing Address
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Address Line | 7401 WILES RD SUITE 150
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-2036
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Country | US
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Telephone | 954-341-7774
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Fax | 480-287-9456
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. SHAWN MICHELLE GORDON
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Credential | LCSW
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Telephone | 954-341-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | SW8335
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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