Provider Demographics
NPI:1386905842
Name:FRESHSTARTS BEHAVIORAL THERAPY LLC
Entity type:Organization
Organization Name:FRESHSTARTS BEHAVIORAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-2286
Mailing Address - Street 1:9360 SW 72ND ST STE 230
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3273
Mailing Address - Country:US
Mailing Address - Phone:305-279-2286
Mailing Address - Fax:305-279-2287
Practice Address - Street 1:9360 SW 72ND ST STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3273
Practice Address - Country:US
Practice Address - Phone:305-279-2286
Practice Address - Fax:305-279-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care