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General NPI Number Information
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NPI Number | 1699597393
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Entity Type | Organization
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Legal Business Name | OUTPATIENT HEALTH VILLAGES SERVICES
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 837 S MAIN STREET
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City | WILDWOOD
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State | FL
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Zip | 34785
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Country | US
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Telephone | 561-815-2649
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 UPLAND DR STE 7672
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City | HOUSTON
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State | TX
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Zip | 77043
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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 | COO
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Name | ANNA ACKNER
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Credential |
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Telephone | 561-815-2649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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