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General NPI Number Information
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NPI Number | 1225529696
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Entity Type | Organization
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Legal Business Name | TURNING TIDES EATING DISORDER TREATMENT CENTER, LLC.
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 4300 MARSH LANDINGS BLVD. #101
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250
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Country | US
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Telephone | 305-632-4863
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Fax |
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Provider Business Mailing Address
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Address Line | 10432 N LAKE VISTA CIR
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City | DAVIE
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State | FL
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Zip | 33328-1140
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Country | US
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Telephone | 305-632-4863
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Fax |
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Authorized Official
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Title or Position | CEO/ CLINICAL DIRECTOR
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Name | MR. ROBERT I YAGODA
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Credential | LMHC
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Telephone | 305-632-4863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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