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General NPI Number Information
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NPI Number | 1265910657
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Entity Type | Organization
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Legal Business Name | LAKE WALES CHARTER SCHOOLS INC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 130 E CENTRAL AVE
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City | LAKE WALES
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State | FL
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Zip | 33853-4166
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Country | US
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Telephone | 863-604-1615
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3309
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City | LAKE WALES
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State | FL
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Zip | 33859-3309
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Country | US
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Telephone | 863-215-8506
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Fax | 863-679-6565
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Authorized Official
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Title or Position | CFO
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Name | MR. ALRICKY SMTIH
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Credential |
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Telephone | 863-215-8506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103T00000X
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Taxonomy Name | Psychologist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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