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1919 Ne 45th St Ste 122 Fort Lauderdale FL 33308-5135 | |
| (954) 776-7176 | |
| (954) 776-7160 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1919 Ne 45th St Ste 122, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Richard Lynn Travis (PRESIDENT) |
| Authorized Official Contact | 9547767176 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1919 Ne 45th St Ste 122 Fort Lauderdale FL 33308-5135 Ph: (954) 776-7176 | 1919 Ne 45th St Ste 122 Fort Lauderdale FL 33308-5135 Ph: (954) 776-7176 |
| NPI Number | 1609042613 |
|---|---|
| Provider Enumeration Date | 04/30/2008 |
| Last Update Date | 04/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609042613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 2294 (Florida) | Primary |
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