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General NPI Number Information
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NPI Number | 1194452631
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Entity Type | Organization
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Legal Business Name | PROSPEROUS BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 4309 W ATLANTIC BLVD APT 917
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1758
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Country | US
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Telephone | 954-338-9738
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Fax |
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Provider Business Mailing Address
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Address Line | 5379 LYONS RD # 1860
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2810
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Country | US
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Telephone | 954-338-9738
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Fax |
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Authorized Official
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Title or Position | PMHNP/OWNER
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Name | FANETTE PROSPERE
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Credential | NP
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Telephone | 954-338-9738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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