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Organization
SHAKE IT UP FOUNDATION LLC
Active
Organization
SHAKE IT UP FOUNDATION LLC
Active
Other names
Krystal Farnum
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL FARNUM M.S. LMHC (CHIEF EXECUTIVE OFFICER)
(570) 540-3465
Entity
Organization
Contact information
Practice address
6919 W BROWARD BLVD STE 151, PLANTATION, FL 33317-2902
(954) 283-0747
Mailing address
6919 W BROWARD BLVD STE 151, PLANTATION, FL 33317-2902
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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