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1621 N Dixie Hwy Fort Lauderdale FL 33305-3138 | |
| (954) 368-6986 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1621 N Dixie Hwy, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Arthur Lee Bain (OWNER) |
| Authorized Official Contact | 9543686986 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
P. O. Box 9511 Fort Lauderdale FL 33310-9511 Ph: () - | 1621 N Dixie Hwy Fort Lauderdale FL 33305-3138 Ph: (954) 368-6986 |
| NPI Number | 1922507177 |
|---|---|
| Provider Enumeration Date | 02/02/2018 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 2466899950 |
|---|---|
| Medicare Enrollment ID | O20240319004167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922507177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Arthur Lee Bain |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487970703 PECOS PAC ID: 3375980865 Enrollment ID: I20240319004179 |
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