Healthcare Provider Details

I. General information

NPI: 1811103351
Provider Name (Legal Business Name): ALEXIS DIAZ LMHC, CBHCMS, ITDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 MADRUGA AVE STE 509
CORAL GABLES FL
33146-3048
US

IV. Provider business mailing address

1550 MADRUGA AVE STE 509
CORAL GABLES FL
33146-3048
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-9714
  • Fax: 786-536-9833
Mailing address:
  • Phone: 786-536-9714
  • Fax: 786-536-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25016
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: