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General NPI Number Information
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NPI Number | 1982971800
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Entity Type | Organization
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Legal Business Name | PALM BEACH BEHAVIORAL HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 221 GREENWICH CIR SUITE 111
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City | JUPITER
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State | FL
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Zip | 33458-2890
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Country | US
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Telephone | 312-758-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 221 GREENWICH CIR SUITE 111
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City | JUPITER
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State | FL
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Zip | 33458-2890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDI RIALS
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Credential | PSYD
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Telephone | 312-758-0424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8421
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License Number State | FL
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