Provider Demographics
NPI:1982971800
Name:PALM BEACH BEHAVIORAL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PALM BEACH BEHAVIORAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIALS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-758-0424
Mailing Address - Street 1:221 GREENWICH CIR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 GREENWICH CIR
Practice Address - Street 2:SUITE 111
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2890
Practice Address - Country:US
Practice Address - Phone:312-758-0424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235419854OtherNPI
1700116829OtherNPI