Provider Demographics
NPI:1467907519
Name:BOUT ME HEALING
Entity Type:Organization
Organization Name:BOUT ME HEALING
Other - Org Name:BOUT ME OM ART & HEALING INK INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:C
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:786-423-5459
Mailing Address - Street 1:20 TAM O SHANTER LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3903
Mailing Address - Country:US
Mailing Address - Phone:786-423-5459
Mailing Address - Fax:
Practice Address - Street 1:3317 NW 10TH TER STE 406
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5941
Practice Address - Country:US
Practice Address - Phone:786-423-5459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOUT ME OM ART & HEALING INK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0050962014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health