Individual
MISS CHANEL ELIZABETH BURTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1527 NE 4TH AVE, FT. LAUDERDALE, FL 33305
(954) 835-5741
Mailing address
1527 NE 4TH AVE, FT. LAUDERDALE, FL 33305
(954) 835-5741
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004010300
—
FL
Enumeration date
08/17/2015
Last updated
08/17/2015
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