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General NPI Number Information
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NPI Number | 1205572849
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Entity Type | Organization
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Legal Business Name | ON-SITE MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 4580 BRIARCLIFF LN
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1734
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Country | US
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Telephone | 954-415-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 4580 BRIARCLIFF LN
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City | COCONUT CREEK
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State | FL
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Zip | 33066-1734
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Country | US
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Telephone | 954-415-8118
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL NICOLE BOULTON
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Credential | LCSW
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Telephone | 954-415-8118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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