Healthcare Provider Details

I. General information

NPI: 1538678172
Provider Name (Legal Business Name): YAOSMEL OLIVARES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8749 NW 107TH LN
HIALEAH GARDENS FL
33018-4618
US

IV. Provider business mailing address

8749 NW 107TH LN
HIALEAH GARDENS FL
33018-4618
US

V. Phone/Fax

Practice location:
  • Phone: 305-323-1344
  • Fax: 305-742-2190
Mailing address:
  • Phone: 305-323-1344
  • Fax: 305-742-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH17691
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8736-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87580
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-21930
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: