Provider Demographics
NPI:1225544232
Name:FLORIDA BEHAVIORAL & HEALTH CONSULTANTS INC
Entity type:Organization
Organization Name:FLORIDA BEHAVIORAL & HEALTH CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-292-4088
Mailing Address - Street 1:3900 HOLLYWOOD BLVD STE PHE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6760
Mailing Address - Country:US
Mailing Address - Phone:954-822-4175
Mailing Address - Fax:
Practice Address - Street 1:3900 HOLLYWOOD BLVD STE PHE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6760
Practice Address - Country:US
Practice Address - Phone:954-822-4175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-0807103TB0200X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020188600Medicaid