Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | FL | |
N | 103TH0004X | Health Psychologist | 193200000X | FL |
Y | 103TH0100X | Health Service | FL |
NPI | 1194392183 |
---|---|
Provider Name | Laphney Gaillard |
First Address | Deerfield Beach, FL 33064-5090 |
Second Address | Deerfield Beach, FL 33064-5090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2021 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05 | (05) | FL |