Provider Demographics
NPI:1528754785
Name:NEXUS BLUE WATER COUNSELING, LLC
Entity type:Organization
Organization Name:NEXUS BLUE WATER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-715-6838
Mailing Address - Street 1:100 S MILITARY TRL STE 11
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S MILITARY TRL STE 11
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3031
Practice Address - Country:US
Practice Address - Phone:954-621-3896
Practice Address - Fax:866-815-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty