MEDICARE: SEPPALA CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	5001	FL

General Provider Information

NPI Number	:	1396104139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEPPALA CORP

Provider Business Mailing Address
First Line	:	2200 N FLORIDA MANGO RD
Second Line	:	SUITE 100
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6404
Country	:	US
Telephone Number	:	561-249-2631
Fax Number	:	561-444-2715

Provider Business Practice Location Address
First Line	:	2200 N FLORIDA MANGO RD
Second Line	:	SUITE 100
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6404
Country	:	US
Telephone Number	:	561-249-2631
Fax Number	:	561-444-6475

Authorized Official
Title or Position	:	MGMR
Name	:	CHI MICAH SEPPALA
Credential	:
Telephone Number	:	561-313-4562

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	07/21/2022

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Directions to “SEPPALA CORP ” Practice Location

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