MEDICARE: EBH SERVICES OF FLORIDA

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP1688752	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP3156662	FL
3	364SF0001X	Family Health Clinical Nurse Specialist	RN9366620	FL
4	2084P0800X	Psychiatry Physician	ME110917	FL

General Provider Information

NPI Number	:	1437519055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBH SERVICES OF FLORIDA

Provider Business Mailing Address
First Line	:	PO BOX 670521
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-0521
Country	:	US
Telephone Number	:	615-567-7282
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 N OAK ST
Second Line	:	SUITE 109
City	:	LANTANA
State	:	FL
Zip	:	33462-3260
Country	:	US
Telephone Number	:	561-337-2600
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, REVENUE CYCLE
Name	:	CHERYL MAPLESDEN
Credential	:	CPC, CHC, CHPC
Telephone Number	:	615-510-3708

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	05/05/2016

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Directions to “EBH SERVICES OF FLORIDA ” Practice Location

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