MEDICARE: S FL BEHAVIORAL HEALTH ASSOC, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1699538140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S FL BEHAVIORAL HEALTH ASSOC, LLC

Provider Business Mailing Address
First Line	:	200 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5525
Country	:	US
Telephone Number	:	954-362-8677
Fax Number	:	954-458-8167

Provider Business Practice Location Address
First Line	:	1250 E HALLANDALE BEACH BLVD STE 700
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4641
Country	:	US
Telephone Number	:	954-362-8677
Fax Number	:	954-458-8167

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE FUNES
Credential	:	PSYD
Telephone Number	:	954-362-8677

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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