Provider Demographics
NPI:1205675089
Name:CONSCIOUSABRAXAS
Entity type:Organization
Organization Name:CONSCIOUSABRAXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:JACKIE
Authorized Official - Last Name:ZEPHIRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-654-0179
Mailing Address - Street 1:4200 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 COMMUNITY DRIVE
Practice Address - Street 2:APT 907
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:540-654-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251S00000XAgenciesCommunity/Behavioral Health