Organization
THE SHORES TREATMENT & RECOVERY SERVICES, LLC
Active
Other names
The Shores
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LYLE RYANT FRIED CAP ICADC (PRESIDENT & CEO)
(772) 800-3990
Entity
Organization
Contact information
Practice address
1405 SE GOLDTREE DR, SUITE A, PORT SAINT LUCIE, FL 34952-7563
(772) 800-3990
Mailing address
1405 SE GOLDTREE DR, SUITE A, PORT SAINT LUCIE, FL 34952-7563
(772) 800-3990
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1956AD703301
FL
101YM0800X
Mental Health Counselor
MH11953
FL
101YP2500X
Professional Counselor
4809
FL
324500000X
Substance Abuse Rehabilitation Facility
Primary
1956AD703301
FL
Other
Enumeration date
08/27/2013
Last updated
02/24/2016
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