Healthcare Provider Details

I. General information

NPI: 1659383560
Provider Name (Legal Business Name): RENE DEL SOL M.A., LMHC, BCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 US HIGHWAY 27 S SUITE 130
AVON PARK FL
33825-9690
US

IV. Provider business mailing address

2523 US HIGHWAY 27 S SUITE 130
AVON PARK FL
33825-9690
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-0710
  • Fax: 863-452-0142
Mailing address:
  • Phone: 863-452-0710
  • Fax: 863-452-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: