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General NPI Number Information
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NPI Number | 1841703592
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PSYCHOLOGICAL SERVICES OF THE PALM BEACHES, LLC
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 9121 N MILITARY TRL STE 207
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-5988
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Country | US
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Telephone | 561-935-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 9121 N MILITARY TRL STE 207
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-5988
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Country | US
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Telephone | 561-935-8905
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JESSICA E MOE
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Credential | PSY.D.
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Telephone | 561-935-8905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PY9142
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License Number State | FL
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