Provider Demographics
NPI:1033167721
Name:SOUTH COUNTY MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:SOUTH COUNTY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, DPA
Authorized Official - Phone:561-637-1000
Mailing Address - Street 1:16158 MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6502
Mailing Address - Country:US
Mailing Address - Phone:561-637-1000
Mailing Address - Fax:561-637-1410
Practice Address - Street 1:16158 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-637-1000
Practice Address - Fax:561-637-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL060276101251B00000X
FL060276100261QM0850X, 261QM0855X, 261QM0801X
FL0950AD962202261QR0405X, 320800000X, 323P00000X
FLAL103013104A0625X
FLPH67933336C0003X
FL650409644343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060276100Medicaid
FL060276101Medicaid