Provider Demographics
NPI:1174059398
Name:BROWARD CENTER FOR COUNSELING
Entity type:Organization
Organization Name:BROWARD CENTER FOR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KREISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-475-9503
Mailing Address - Street 1:8030 PETERS ROAD
Mailing Address - Street 2:SUITE D-106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-475-9503
Mailing Address - Fax:954-476-2369
Practice Address - Street 1:8030 PETERS RD
Practice Address - Street 2:SUITE D-106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4038
Practice Address - Country:US
Practice Address - Phone:954-475-9503
Practice Address - Fax:954-476-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5055101YA0400X
FLMH1868101YM0800X
FLMH10854101YM0800X
FLPY0003936103T00000X
FLPY5840103TC0700X
FLPY7288103TC0700X
FLMT22741041C0700X
FLMH0007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019032900Medicaid
FL1790834000Medicare UPIN