Provider Demographics
NPI:1699539403
Name:FULL LIFE COACHING PLLC
Entity type:Organization
Organization Name:FULL LIFE COACHING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:954-696-4001
Mailing Address - Street 1:4400 N FEDERAL HWY STE 307
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5180
Mailing Address - Country:US
Mailing Address - Phone:954-696-4001
Mailing Address - Fax:
Practice Address - Street 1:4400 N FEDERAL HWY STE 307
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5180
Practice Address - Country:US
Practice Address - Phone:954-696-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULL LIFE COMPREHENSIVE CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health