Healthcare Provider Details

I. General information

NPI: 1407155302
Provider Name (Legal Business Name): INTERNATIONAL INSTITUTE FOR THERAPEUTIC HEALING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10305 NW 41 ST. SUITE 202
DORAL FL
33178
US

IV. Provider business mailing address

620 SO. SHETLAND ST.
CLEWISTON FL
33440
US

V. Phone/Fax

Practice location:
  • Phone: 786-262-0346
  • Fax:
Mailing address:
  • Phone: 786-262-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP 1670
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6878
License Number StateFL

VIII. Authorized Official

Name: MS. GELIANI REINA LOPEZ
Title or Position: PRESIDENT
Credential: LMHC
Phone: 786-262-0346