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General NPI Number Information
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NPI Number | 1811513450
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Entity Type | Individual
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Provider Name | ANTWAN MCKENZIE-PLEZ
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Gender | Male
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 800 NE 62ND ST STE 406
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-3522
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Country | US
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Telephone | 954-412-9698
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1298
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City | POMPANO BEACH
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State | FL
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Zip | 33061-1298
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Country | US
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Telephone | 786-260-3520
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Fax | 954-697-0980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MH18613
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License Number State | FL
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