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General NPI Number Information
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NPI Number | 1205675089
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Entity Type | Organization
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Legal Business Name | CONSCIOUSABRAXAS
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4200 COMMUNITY DRIVE APT 907
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City | WEST PALM BEACH
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State | FL
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Zip | 33409
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Country | US
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Telephone | 540-654-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 COMMUNITY DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-2742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR TECHNICIAN
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Name | JEFF JACKIE ZEPHIRIN
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Credential |
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Telephone | 540-654-0179
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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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