1881130094 NPI number — NORTHLAKE CENTER FOR COUNSELING

Table of content: (NPI 1881130094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881130094 NPI number — NORTHLAKE CENTER FOR COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHLAKE CENTER FOR COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881130094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1851 WEST INDIANTOWN ROAD
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-743-7959
Provider Business Mailing Address Fax Number:
561-743-7959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 WEST INDIANTOWN ROAD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-743-7958
Provider Business Practice Location Address Fax Number:
561-743-7959
Provider Enumeration Date:
01/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-743-7958

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH4748 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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