Healthcare Provider Details

I. General information

NPI: 1457745275
Provider Name (Legal Business Name): TATIANA ESCANDON LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W BROWARD BLVD SUITE 100
FORT LAUDERDALE FL
33312-1018
US

IV. Provider business mailing address

3800 W BROWARD BLVD SUITE 100
FORT LAUDERDALE FL
33312-1018
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-1008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: