Provider Demographics
NPI:1871744284
Name:CPMH PROFESSIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:CPMH PROFESSIONAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CHOUTE
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-895-1465
Mailing Address - Street 1:2845 SW 176TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5556
Mailing Address - Country:US
Mailing Address - Phone:954-895-1465
Mailing Address - Fax:954-433-3236
Practice Address - Street 1:2845 SW 176TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5556
Practice Address - Country:US
Practice Address - Phone:954-895-1465
Practice Address - Fax:954-433-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2679592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308310100Medicaid
FLAF767ZMedicare PIN