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General NPI Number Information
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NPI Number | 1396104139
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Entity Type | Organization
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Legal Business Name | SEPPALA CORP
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2200 N FLORIDA MANGO RD SUITE 100
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6404
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Country | US
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Telephone | 561-249-2631
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Fax | 561-444-6475
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Provider Business Mailing Address
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Address Line | 2200 N FLORIDA MANGO RD SUITE 100
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6404
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Country | US
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Telephone | 561-249-2631
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Fax | 561-444-2715
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Authorized Official
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Title or Position | MGMR
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Name | CHI MICAH SEPPALA
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Credential |
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Telephone | 561-313-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5001
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License Number State | FL
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