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General NPI Number Information
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NPI Number | 1386404713
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Entity Type | Organization
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Legal Business Name | BOUT ME HEALING
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 9858 CLINT MOORE RD STE C111-202
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 786-472-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD STE C111-202
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 786-472-0220
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Fax |
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Authorized Official
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Title or Position | CEO/MNG
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Name | CICE RIVERA GONZALEZ
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Credential | CAP
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Telephone | 786-472-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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