Provider Demographics
NPI:1356646921
Name:HIBISCUS CHILDRENS CENTER
Entity Type:Organization
Organization Name:HIBISCUS CHILDRENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:772-882-4074
Mailing Address - Street 1:5091 E PORTOFINO LANDINGS BLVD
Mailing Address - Street 2:UNIT 201
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-5444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5091 E PORTOFINO LANDINGS BLVD
Practice Address - Street 2:UNIT 201
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5444
Practice Address - Country:US
Practice Address - Phone:772-882-4074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare