Provider Demographics
NPI:1013461870
Name:OCEAN BLUE COUNSELING GROUP
Entity Type:Organization
Organization Name:OCEAN BLUE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-799-1761
Mailing Address - Street 1:2300 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1100
Mailing Address - Country:US
Mailing Address - Phone:724-799-1761
Mailing Address - Fax:
Practice Address - Street 1:2300 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1100
Practice Address - Country:US
Practice Address - Phone:724-799-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW128631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty