Provider Demographics
NPI:1205572849
Name:ON-SITE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ON-SITE MENTAL HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-415-8118
Mailing Address - Street 1:4580 BRIARCLIFF LN
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1734
Mailing Address - Country:US
Mailing Address - Phone:954-415-8118
Mailing Address - Fax:
Practice Address - Street 1:4580 BRIARCLIFF LN
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1734
Practice Address - Country:US
Practice Address - Phone:954-415-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health