Healthcare Provider Details

I. General information

NPI: 1982907176
Provider Name (Legal Business Name): GABRIELA GALVAN DE ANTILLON M.S, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PONCE DE LEON BLVD SUITE 212
CORAL GABLES FL
33134-3353
US

IV. Provider business mailing address

PO BOX 226456
MIAMI FL
33222-6456
US

V. Phone/Fax

Practice location:
  • Phone: 786-383-2738
  • Fax:
Mailing address:
  • Phone: 786-383-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: