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General NPI Number Information
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NPI Number | 1679932081
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Entity Type | Organization
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Legal Business Name | COOL SPIRIT PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 300 GEORGE BUSH BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33444-4036
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Country | US
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Telephone | 561-859-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 600 SNUG HARBOR DR. A9
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City | BOYNTON BEACH
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State | FL
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Zip | 33435
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Country | US
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Telephone | 561-596-1602
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. MATTHEW FANALI JR.
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Credential | L.M.H.C., C.A.P.
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Telephone | 561-596-1602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | MH 12642
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License Number State | FL
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