Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 95421 | |
N | 225C00000X | Rehabilitation Counselor | FL |
NPI | 1164175923 |
---|---|
Provider Name | Laura Pantouris |
First Address | Boca Raton, FL 33497-2560 |
Second Address | Pompano Beach, FL 33060-5621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |