Provider Demographics
NPI:1164663571
Name:PROFESSIONAL TRAINING ASSOCIATION
Entity Type:Organization
Organization Name:PROFESSIONAL TRAINING ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-816-7151
Mailing Address - Street 1:8358 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7319
Mailing Address - Country:US
Mailing Address - Phone:954-816-7151
Mailing Address - Fax:
Practice Address - Street 1:8358 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7319
Practice Address - Country:US
Practice Address - Phone:954-816-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 103T00000X, 103TC0700X, 103TF0200X, 104100000X
FLBY7137103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLIED FORMedicaid