1952324253 NPI number — MRS. MELISSA ORTIZ-BECHER PY

Table of content: KAREN SHANKS MS, LPC (NPI 1063622991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952324253 NPI number — MRS. MELISSA ORTIZ-BECHER PY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ-BECHER
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTIZ-MATOS
Provider Other First Name:
MELISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSYD, LMHC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952324253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11419 MILLPOND GREENS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33473-7803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-906-7764
Provider Business Mailing Address Fax Number:
561-736-5178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 WEST PALMETTO PARK RD.
Provider Second Line Business Practice Location Address:
SUITE 104 B
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-368-9940
Provider Business Practice Location Address Fax Number:
561-736-5178
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH8182 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: PY7318 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PY7318 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: PY7318 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024091800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".