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NPI Code Detail

MEDICARE: COLLEGIATE BEHAVIORAL HEALTH ASSOCIATES

MEDICARE: COLLEGIATE BEHAVIORAL HEALTH ASSOCIATES
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1720784259
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLEGIATE BEHAVIORAL HEALTH ASSOCIATES
Provider Business Mailing Address
First Line : 7000 W PALMETTO PARK RD STE 308
Second Line :
City : BOCA RATON
State : FL
Zip : 33433-3429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6809 SAWGRASS DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-7103
Country : US
Telephone Number : 833-244-5700
Fax Number :
Authorized Official
Title or Position : BILLING MGR
Name : SHARON BLACK
Credential :
Telephone Number : 214-579-9151
Provider Enumeration Date : 02/06/2023
Last Update Date : 02/06/2023

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