Healthcare Provider Details

I. General information

NPI: 1578362257
Provider Name (Legal Business Name): COMPASSIONATE HEALING INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CORAL RIDGE DR
CORAL SPRINGS FL
33071-4180
US

IV. Provider business mailing address

809 CORAL RIDGE DR
CORAL SPRINGS FL
33071-4180
US

V. Phone/Fax

Practice location:
  • Phone: 561-679-1139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: LISSETTE CORTES
Title or Position: MANAGER
Credential:
Phone: 786-556-6592