Provider Demographics
NPI:1275699621
Name:FLORIDA PERSONAL GROWTH CENTER, INC
Entity Type:Organization
Organization Name:FLORIDA PERSONAL GROWTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-733-3394
Mailing Address - Street 1:3511 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3331
Mailing Address - Country:US
Mailing Address - Phone:954-733-3394
Mailing Address - Fax:954-733-4483
Practice Address - Street 1:3511 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3331
Practice Address - Country:US
Practice Address - Phone:954-733-3394
Practice Address - Fax:954-733-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty