MEDICARE: MB MENTAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568189264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MB MENTAL THERAPY INC

Provider Business Mailing Address
First Line	:	7545 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4123
Country	:	US
Telephone Number	:	786-469-1613
Fax Number	:

Provider Business Practice Location Address
First Line	:	7545 NW 2ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4123
Country	:	US
Telephone Number	:	786-469-1613
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAYELIN BATISTA GUILLEN
Credential	:
Telephone Number	:	786-469-1613

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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Directions to “MB MENTAL THERAPY INC ” Practice Location

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