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General NPI Number Information
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NPI Number | 1699153957
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Entity Type | Organization
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Legal Business Name | LIFE TRACKS TREATMENT CENTER LLC.
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 100 S MILITARY TRL SUITE 7
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-3015
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Country | US
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Telephone | 954-800-4111
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Fax | 954-800-4112
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Provider Business Mailing Address
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Address Line | 100 S MILITARY TRL SUITE 7
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-3015
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Country | US
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Telephone | 954-800-4111
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Fax | 954-800-4112
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. ALEJANDRO LAZARO CASTILLO
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Credential | LMHC, LMFT, CAP
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Telephone | 954-800-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MH8360
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License Number State | FL
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