=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558695122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR BEHAVIORAL SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2009
-----------------------------------------------------
Last Update Date | 09/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 S PINE ISLAND RD A-150
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-3918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-632-1983
-----------------------------------------------------
Fax | 954-653-2965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 WESTTREE LN
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-1863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-632-1983
-----------------------------------------------------
Fax | 954-653-2965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JO MYRTHO JEAN CHARLES
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 954-632-1983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | MH8948
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------