Provider Demographics
NPI:1104344225
Name:RELAX BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:RELAX BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROESSER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC CAP SAP CRC LPN
Authorized Official - Phone:561-398-8336
Mailing Address - Street 1:2809 POINSETTIA AVE STE 12&6
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-5426
Mailing Address - Country:US
Mailing Address - Phone:561-469-9934
Mailing Address - Fax:888-972-4983
Practice Address - Street 1:2809 POINSETTIA AVE STE 1,2&6
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5426
Practice Address - Country:US
Practice Address - Phone:561-469-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11045261QR0405X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder