Organization
SPANISH RIVER CHURCH
Active
Parent organization
SPANISH RIVER CHURCH
Other names
Spanish River Counseling Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPANISH RIVER CHURCH
Authorized official
DR. BRENT GRAY PH.D. (CLINICAL DIRECTOR)
(561) 241-9014
Entity
Organization
Contact information
Practice address
2400 YAMATO RD, BOCA RATON, FL 33431-8403
(561) 241-9014
(561) 994-2263
Mailing address
2400 YAMATO RD, BOCA RATON, FL 33431-8403
(561) 241-9014
(561) 994-2263
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6752
FL
Other
Enumeration date
05/01/2012
Last updated
05/01/2012
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