Provider Demographics
NPI:1902479272
Name:COLLABORATIVE HEALTHCARE SERVICES, LLC.
Entity Type:Organization
Organization Name:COLLABORATIVE HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOVE-COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-551-8460
Mailing Address - Street 1:2042 CORAL HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5223
Mailing Address - Country:US
Mailing Address - Phone:954-551-8460
Mailing Address - Fax:
Practice Address - Street 1:2042 CORAL HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308-5223
Practice Address - Country:US
Practice Address - Phone:954-551-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1588933550OtherNPI