Provider Demographics
NPI:1336254929
Name:PROFESSIONAL HEALTH NETWORK INC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-274-4330
Mailing Address - Street 1:10631 N KENDALL DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1568
Mailing Address - Country:US
Mailing Address - Phone:305-274-4330
Mailing Address - Fax:305-274-3822
Practice Address - Street 1:10631 N KENDALL DR
Practice Address - Street 2:SUITE 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1568
Practice Address - Country:US
Practice Address - Phone:305-274-4330
Practice Address - Fax:305-274-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD055601101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty