Organization
BASIC LIFE SUPPORT THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE MAUGHN (ADM)
(954) 579-9935
Entity
Organization
Contact information
Practice address
3561 POWERLINE RD, OAKLAND PARK, FL 33309-5928
(954) 579-9935
Mailing address
3561 POWERLINE RD, OAKLAND PARK, FL 33309-5928
(954) 579-9935
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1380
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
4015A
FL
106S00000X
Behavior Technician
1216
FL
Other
Enumeration date
09/30/2016
Last updated
09/30/2016
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