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General NPI Number Information
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NPI Number | 1184193369
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Entity Type | Individual
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Provider Name | JEAN-MICHAEL BOUCIQUOT LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/17/2018
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Last Update Date | 11/17/2018
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Provider Practice Location Address
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Address Line | 11011 SHERIDAN ST STE 211
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City | HOLLYWOOD
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State | FL
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Zip | 33026-1531
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Country | US
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Telephone | 305-934-8832
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Fax |
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Provider Business Mailing Address
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Address Line | 11288 SW 9TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-4304
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Country | US
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Telephone | 305-934-8832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3593
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License Number State | FL
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