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General NPI Number Information
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NPI Number | 1679762413
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Entity Type | Organization
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Legal Business Name | GP WELLNESS PLLC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 12230 FOREST HILL BLVD SUITE 152
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City | WELLINGTON
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State | FL
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Zip | 33414-5700
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Country | US
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Telephone | 561-358-9414
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Fax |
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Provider Business Mailing Address
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Address Line | 3690 MIRAMONTES CIR
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City | WELLINGTON
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State | FL
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Zip | 33414
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENCE MENTAL HEALTH C
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Name | GRACIELA PEREZ
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Credential | LICENCE MENTAL HEALT
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Telephone | 561-358-9414
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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 | MH9077
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License Number State | FL
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