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General NPI Number Information
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NPI Number | 1760893630
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY SERVICES
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 398 CAMINO GARDENS BLVD SUITE 101
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City | BOCA RATON
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State | FL
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Zip | 33432-5827
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Country | US
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Telephone | 954-399-2093
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Fax | 954-463-4609
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Provider Business Mailing Address
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Address Line | 398 CAMINO GARDENS BLVD SUITE 101
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City | BOCA RATON
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State | FL
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Zip | 33432-5827
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Country | US
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Telephone | 954-399-2093
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Fax | 954-463-4609
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEWIS J JORDAN
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Credential | LMHC
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Telephone | 954-399-2093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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