Basic Information
Provider Information | |||||||||
NPI: | 1700209897 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | GUIDANCE/CARE CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 411 FLEMING ST | ||||||||
Address2: |   | ||||||||
City: | KEY WEST | ||||||||
State: | FL | ||||||||
PostalCode: | 330406528 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052931992 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1205 4TH ST | ||||||||
Address2: |   | ||||||||
City: | KEY WEST | ||||||||
State: | FL | ||||||||
PostalCode: | 330403707 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3054347660 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2014 | ||||||||
LastUpdateDate: | 01/27/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KEMPA | ||||||||
AuthorizedOfficialFirstName: | MAUREEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR, CHILDREN & FAMILIES | ||||||||
AuthorizedOfficialTelephone: | 3054347660 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | WESTCARE | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MA, NCC, LMHC | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 1982730743 | NV | Y |   | Agencies | Case Management |   |
No ID Information.