Provider Demographics
NPI:1427665322
Name:SALUBRIOUS PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:SALUBRIOUS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IME
Authorized Official - Middle Name:
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-465-4177
Mailing Address - Street 1:6511 NOVA DR # 176
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6511 NOVA DR # 176
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7401
Practice Address - Country:US
Practice Address - Phone:954-465-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty