Provider Demographics
NPI:1982140471
Name:MARCIA GONCALVES TERLEP INC.
Entity Type:Organization
Organization Name:MARCIA GONCALVES TERLEP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONCALVES -TERLEP
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:561-308-8191
Mailing Address - Street 1:1354 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5066
Mailing Address - Country:US
Mailing Address - Phone:561-308-8191
Mailing Address - Fax:561-439-3707
Practice Address - Street 1:2324 S CONGRESS AVE STE 1F
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7667
Practice Address - Country:US
Practice Address - Phone:561-308-8191
Practice Address - Fax:561-439-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty