MEDICARE: CELEBRITY TREATMENT CENTER INC

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	363L00000X	Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1548967060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELEBRITY TREATMENT CENTER INC

Provider Business Mailing Address
First Line	:	6005 NW 68TH TER
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-5676
Country	:	US
Telephone Number	:	954-825-5796
Fax Number	:

Provider Business Practice Location Address
First Line	:	6005 NW 68TH TER
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-5676
Country	:	US
Telephone Number	:	954-825-5796
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	GUERLINE VEILLARD
Credential	:	NURSE PRACTITIONER
Telephone Number	:	954-825-5796

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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