Provider Demographics
NPI:1396104139
Name:SEPPALA CORP
Entity type:Organization
Organization Name:SEPPALA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGMR
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:MICAH
Authorized Official - Last Name:SEPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-313-4562
Mailing Address - Street 1:2200 N FLORIDA MANGO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6404
Mailing Address - Country:US
Mailing Address - Phone:561-249-2631
Mailing Address - Fax:561-444-2715
Practice Address - Street 1:2200 N FLORIDA MANGO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6404
Practice Address - Country:US
Practice Address - Phone:561-249-2631
Practice Address - Fax:561-444-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty