MEDICARE: EXCEPTIONAL MINDS CHILD & ADOLESCENTS THERAPEUTIC SERVICES 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801218078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL MINDS CHILD & ADOLESCENTS THERAPEUTIC SERVICES INC

Provider Business Mailing Address
First Line	:	80 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-3003
Country	:	US
Telephone Number	:	305-423-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 N BISCAYNE RIVER DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-6215
Country	:	US
Telephone Number	:	305-423-7140
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANTONIO JOHNSON
Credential	:
Telephone Number	:	305-423-7140

Provider Enumeration Date	:	01/07/2014
Last Update Date	:	04/29/2014

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