Provider Demographics
| NPI: | 1699531905 |
|---|---|
| Name: | ALTHA MENTAL HEALTH INSTITUTE LLC |
| Entity type: | Organization |
| Organization Name: | ALTHA MENTAL HEALTH INSTITUTE LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROBERTA |
| Authorized Official - Middle Name: | P |
| Authorized Official - Last Name: | DECASTRO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LMHC |
| Authorized Official - Phone: | 561-441-1539 |
| Mailing Address - Street 1: | 21301 POWERLINE RD STE 103 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BOCA RATON |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33433-2389 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 561-441-1539 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 21301 POWERLINE RD STE 103 |
| Practice Address - Street 2: | |
| Practice Address - City: | BOCA RATON |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33433-2389 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 561-441-1539 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-02-23 |
| Last Update Date: | 2024-02-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
| No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
