Provider Demographics
NPI:1396224028
Name:PALM BEACH THERAPY AND HEALTH LLC
Entity Type:Organization
Organization Name:PALM BEACH THERAPY AND HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLWINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT LMHC
Authorized Official - Phone:561-889-9198
Mailing Address - Street 1:15903 CYPRESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6348
Mailing Address - Country:US
Mailing Address - Phone:561-889-9198
Mailing Address - Fax:
Practice Address - Street 1:12798 FOREST HILL BLVD STE 303
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4704
Practice Address - Country:US
Practice Address - Phone:561-237-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty