Provider Demographics
NPI:1831543206
Name:RECREATE LIFE COUNSELING
Entity type:Organization
Organization Name:RECREATE LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-814-2055
Mailing Address - Street 1:455 NE 5TH AVE # D306
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5658
Mailing Address - Country:US
Mailing Address - Phone:561-814-2055
Mailing Address - Fax:
Practice Address - Street 1:3652 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-8662
Practice Address - Country:US
Practice Address - Phone:561-814-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty