Provider Demographics
NPI:1508141110
Name:ASHLEE COMEAU, INC.
Entity Type:Organization
Organization Name:ASHLEE COMEAU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-656-1006
Mailing Address - Street 1:8728 WOODGROVE HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4840
Mailing Address - Country:US
Mailing Address - Phone:561-656-1006
Mailing Address - Fax:561-656-1006
Practice Address - Street 1:1300 CORPORATE CENTER WAY
Practice Address - Street 2:105C
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8599
Practice Address - Country:US
Practice Address - Phone:561-656-1006
Practice Address - Fax:561-656-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10878251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health