=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689982415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFINITE BEHAVIORAL HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2010
-----------------------------------------------------
Last Update Date | 12/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2421 HOLLYWOOD BLVD SUITE 1 AND 2
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-6605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-923-9111
-----------------------------------------------------
Fax | 954-923-9190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2421 HOLLYWOOD BLVD. SUITE 1 AND 2
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020-6711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-309-5667
-----------------------------------------------------
Fax | 305-935-3172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. NATALIE ALAZRACHI
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 305-915-0551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TP0016X
-----------------------------------------------------
Taxonomy Name | Prescribing (Medical) Psychologist
-----------------------------------------------------
License Number | ME63070
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY7670
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------