Provider Demographics
NPI:1982225454
Name:FULL CIRCLE THERAPY LLC
Entity Type:Organization
Organization Name:FULL CIRCLE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIESGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-701-3854
Mailing Address - Street 1:16446 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1314
Mailing Address - Country:US
Mailing Address - Phone:954-701-3854
Mailing Address - Fax:
Practice Address - Street 1:2645 EXECUTIVE PARK DR STE 149
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3624
Practice Address - Country:US
Practice Address - Phone:964-701-3854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty