Provider Demographics
NPI:1982080677
Name:CLIENT SUPPORT ALLIANCE, LLC.
Entity Type:Organization
Organization Name:CLIENT SUPPORT ALLIANCE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-234-9166
Mailing Address - Street 1:2450 SW 137TH AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 SW 137TH AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8802
Practice Address - Country:US
Practice Address - Phone:786-234-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC8687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL597120Medicaid