Provider Demographics
NPI:1811861511
Name:PURE SERENITY MENTAL WELLNESS LLC
Entity type:Organization
Organization Name:PURE SERENITY MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:005-457-5707
Mailing Address - Street 1:9955 NW 49TH PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2472
Mailing Address - Country:US
Mailing Address - Phone:941-281-4038
Mailing Address - Fax:
Practice Address - Street 1:1489 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3325
Practice Address - Country:US
Practice Address - Phone:941-281-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty