Provider Demographics
NPI:1790211241
Name:HIGH, MAX EUGENE JR (THD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:EUGENE
Last Name:HIGH
Suffix:JR
Gender:M
Credentials:THD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-2731
Mailing Address - Country:US
Mailing Address - Phone:352-429-5600
Mailing Address - Fax:
Practice Address - Street 1:611 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-2731
Practice Address - Country:US
Practice Address - Phone:352-429-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCMFT0453020715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist