Healthcare Provider Details

I. General information

NPI: 1619313186
Provider Name (Legal Business Name): LIFESTAR MENTAL WELLNESS CENTER INC, CMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 W 84TH ST STE 108
HIALEAH FL
33018-4935
US

IV. Provider business mailing address

3416 W 84TH ST STE 108
HIALEAH FL
33018-4935
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-1555
  • Fax: 786-442-2176
Mailing address:
  • Phone: 786-303-5079
  • Fax: 786-442-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNY A BERNAL
Title or Position: CEO/CFO
Credential: RMHCI
Phone: 786-303-5079