Provider Demographics
NPI:1538870001
Name:YOUR NARRATIVE COUNSELING & THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:YOUR NARRATIVE COUNSELING & THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLYANN
Authorized Official - Middle Name:MOORE HINES
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:754-400-1689
Mailing Address - Street 1:1946 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4517
Mailing Address - Country:US
Mailing Address - Phone:754-400-1689
Mailing Address - Fax:
Practice Address - Street 1:1946 TYLER ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4517
Practice Address - Country:US
Practice Address - Phone:754-400-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR NARRATIVE COUNSELING & THERAPEUTIC SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023511900Medicaid