Organization Name: | DYNAMIC OUTPATIENT THERAPEUTIC SERVICES, LLC |
NPI Number: | 1073989273 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHAYNA RAYMAN (MANAGING MEMBER) |
Mailing Address: | 2312 Wilton Dr Wilton Manors |
State: | FL US |
Postal Code: | 333051249 |
Phone Number: | 9547457917 |
Fax Number: | 9547457918 |
NPI Enumeration Date: | 08/11/2015 |
NPI Last Update Date: | 08/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 11511 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |