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Organization
BROKEN CYCLE
Active
Organization
BROKEN CYCLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JESSICA K. COUTAIN (OWNER)
(954) 851-4640
Entity
Organization
Contact information
Practice address
2825 SW 14TH ST, FORT LAUDERDALE, FL 33312-3906
(954) 851-4640
Mailing address
2825 SW 14TH ST, FORT LAUDERDALE, FL 33312-3906
(954) 851-4640
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH 14023
FL
Other
Enumeration date
06/28/2016
Last updated
06/28/2016
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