Organization · Type 2 NPI

Shake It Up Foundation LLC

Mental Health Clinic/Center (Including Community Mental Health Center) · Plantation, FL

NPI number 1457983777 Active

Practice location

6919 W Broward Blvd Ste 151
Plantation, FL 33317-2902

Specialties and licenses

Taxonomy	Code	License
Mental Health Clinic/Center (Including Community Mental Health Center) Primary	261QM0801X	None listed
Adult Mental Health Clinic/Center	261QM0850X	None listed
Adolescent and Children Mental Health Clinic/Center	261QM0855X	None listed

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

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NPI record

NPI: 1457983777
Entity type: Organization (Type 2)
Issued: Feb 5, 2020
Last updated: Feb 5, 2020
Status: Active

Other names

<unavail>
Krystal Farnum · doing business as
Krystal Farnum · doing business as

Authorized official

Krystal Farnum, M.S. LMHC
Chief Executive Officer
(570) 540-3465

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1457983777

Shake It Up Foundation LLC's National Provider Identifier is 1457983777, issued on Feb 5, 2020. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Plantation, FL. The record was last updated on Feb 5, 2020.