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General NPI Number Information
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NPI Number | 1710344593
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC INNOVATIVE PASSAGES SOLUTIONS
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 2999 NE 191ST ST 703
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City | AVENTURA
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State | FL
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Zip | 33180-3123
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Country | US
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Telephone | 305-931-5151
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Fax | 305-405-6171
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Provider Business Mailing Address
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Address Line | 2030 S OCEAN DR 1911
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-6649
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Country | US
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Telephone | 305-338-2363
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. EDWARD MARK DRIVER
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Credential | LCSW
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Telephone | 305-338-2363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW1114
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License Number State | FL
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