Provider Demographics
NPI:1164535092
Name:TRINITY HARBOR THERAPEUTIC SERVICES, INC.
Entity Type:Organization
Organization Name:TRINITY HARBOR THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-341-7774
Mailing Address - Street 1:7401 WILES RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2036
Mailing Address - Country:US
Mailing Address - Phone:954-341-7774
Mailing Address - Fax:480-287-9456
Practice Address - Street 1:7401 WILES RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2036
Practice Address - Country:US
Practice Address - Phone:954-341-7774
Practice Address - Fax:480-287-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW8335302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty