# BASIC LIFE SUPPORT THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366991416
- **Authorized official:** KATHERINE MAUGHN (ADM)
- **Authorized official phone:** (954) 579-9935

## Contact information

- **Practice address:** 3561 POWERLINE RD, OAKLAND PARK, FL 33309-5928
- **Practice address phone:** (954) 579-9935
- **Mailing address:** 3561 POWERLINE RD, OAKLAND PARK, FL 33309-5928
- **Mailing address phone:** (954) 579-9935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 1380 | FL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 4015A | FL | — |
| 106S00000X | Behavior Technician | 1216 | FL | — |

## Other

- **Enumeration date:** 09/30/2016
- **Last updated:** 09/30/2016