Healthcare Provider Details

I. General information

NPI: 1114760659
Provider Name (Legal Business Name): HEALING SOULS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 NW 41ST ST STE 200
DORAL FL
33166-6204
US

IV. Provider business mailing address

9725 FONTAINEBLEAU BLVD APT 205
MIAMI FL
33172-4025
US

V. Phone/Fax

Practice location:
  • Phone: 786-241-7695
  • Fax: 786-765-5257
Mailing address:
  • Phone: 305-399-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROMY RODRIGUEZ
Title or Position: OWNER
Credential: LMHC
Phone: 786-241-7695