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General NPI Number Information
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NPI Number | 1215668041
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Entity Type | Organization
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Legal Business Name | SOFLO BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 306 W MANGO ST STE A
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City | LANTANA
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State | FL
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Zip | 33462-2835
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Country | US
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Telephone | 954-297-9802
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Fax | 561-431-5873
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Provider Business Mailing Address
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Address Line | 306 W MANGO ST STE A
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City | LANTANA
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State | FL
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Zip | 33462-2835
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Country | US
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Telephone | 954-297-9802
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Fax | 561-431-5873
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Authorized Official
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Title or Position | CEO
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Name | LESLIE G BRAVO
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Credential |
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Telephone | 954-297-9802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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