Provider Information for 1982225454
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FULL CIRCLE THERAPY LLC
Other Names:Doing Business As:FULL CIRCLE THERAPY LLCOrganization Subpart: NO
NPI: 1982225454
Last Updated: 2020-05-06
Certification Date: 2020-05-06
Certification Date: 2020-05-06
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1982225454 | ||||||||
| Enumeration Date | 2020-05-06 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: Mrs. MELISSA M RIESGO LMHC Title: Psychotherapist Phone: 9547013854 | ||||||||
| Mailing Address | 16446 NW 14TH ST PEMBROKE PINES, FL 33028-1314 United States Phone: 954-701-3854 | Fax: | ||||||||
| Primary Practice Address | 2645 EXECUTIVE PARK DR STE 149 WESTON, FL 33331-3624 United States Phone: 964-701-3854 | Fax: | ||||||||
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