Provider Demographics
NPI:1447295761
Name:THERAPEUTIC ALLIANCE COMMUNITY MENTAL HEALTH CENTER INC
Entity type:Organization
Organization Name:THERAPEUTIC ALLIANCE COMMUNITY MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BODAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:305-871-3131
Mailing Address - Street 1:6405 NW 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6974
Mailing Address - Country:US
Mailing Address - Phone:305-871-3131
Mailing Address - Fax:305-871-2727
Practice Address - Street 1:6405 NW 36TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6974
Practice Address - Country:US
Practice Address - Phone:305-871-3131
Practice Address - Fax:305-871-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7230261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD431OtherPTAN
FLAD431OtherPTAN