Provider Demographics
NPI:1396219549
Name:COUTURE, MAXWELL T (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:T
Last Name:COUTURE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 VIA DE CASAS NORTE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8807
Mailing Address - Country:US
Mailing Address - Phone:239-692-2726
Mailing Address - Fax:
Practice Address - Street 1:82 VIA DE CASAS NORTE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8807
Practice Address - Country:US
Practice Address - Phone:239-692-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health