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General NPI Number Information
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NPI Number | 1922512136
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Entity Type | Organization
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Legal Business Name | RKG PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 2900 N UNIVERSITY DR STE 30
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5083
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Country | US
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Telephone | 954-648-3974
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 N UNIVERSITY DR STE 30
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5083
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Country | US
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Telephone | 954-648-3974
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. REBECCA KELLY GORCHOFF
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Credential | LMHC
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Telephone | 954-648-3974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH13360
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License Number State | FL
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