NPIMap

Organization Active NPI

Professional Training Association Corporation

  • Substance Use Disorder Rehabilitation Clinic/Center
  • North Palm Baech, FL
National Provider Identifier
1013059401
Registry record updated Feb 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
0950AD384702 Issued in FL
Legal business name
PROFESSIONAL TRAINING ASSOCIATION CORPORATION
Practice address
321 Northlake Blvd
#102
North Palm Baech, FL 33408
Phone
(561) 494-0866
Fax
(561) 494-0984
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mitchell E. WallickNPI 1811130719
Title
Executive Director
Phone
(561) 494-0866

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X FL
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 1550AD384701 FL
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 0950AD384702 FL Primary

Addresses

Primary practice location

321 Northlake Blvd
#102
North Palm Baech, FL 33408

Mailing address

321 Northlake Blvd
Suite 102
North Palm Beach, FL 33408-5422
Phone (561) 494-0866

National Provider Directory

National Provider Directory

Locations

321 Northlake Blvd
Ste 102
North Palm Beach, FL 33408
Phone (561) 494-0866

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392076800000",
    "number": "1013059401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 NORTHLAKE BLVD",
            "address_2": "SUITE 102",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334085422",
            "telephone_number": "561-494-0866",
            "fax_number": "561-494-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 NORTHLAKE BLVD",
            "address_2": "#102",
            "city": "NORTH PALM BAECH",
            "state": "FL",
            "postal_code": "33408",
            "telephone_number": "561-494-0866",
            "fax_number": "561-494-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL TRAINING ASSOCIATION CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2014-02-11",
        "status": "A",
        "authorized_official_last_name": "WALLICK",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "561-494-0866",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "1550AD384701",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "FL",
            "license": "0950AD384702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.