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General NPI Number Information
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NPI Number | 1568769057
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Entity Type | Organization
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Legal Business Name | SPECIALIZED TREATMENT, EDUCATION AND PREVENTION SERVICES, INC.
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 2400 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-5076
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Country | US
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Telephone | 321-637-7730
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Fax | 321-639-5721
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Provider Business Mailing Address
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Address Line | 2400 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-5076
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Country | US
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Telephone | 321-637-7730
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Fax | 321-639-5721
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KATHLEEN TURNER
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Credential | MS CCJAP
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Telephone | 321-637-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1805AD398603
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License Number State | FL
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