Healthcare Provider Details

I. General information

NPI: 1215861661
Provider Name (Legal Business Name): MLIP PSYCHOTHERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 W 60TH PL APT 105
HIALEAH FL
33016-4352
US

IV. Provider business mailing address

2511 W 60TH PL APT 105
HIALEAH FL
33016-4352
US

V. Phone/Fax

Practice location:
  • Phone: 786-333-0376
  • Fax:
Mailing address:
  • Phone: 786-333-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MAY LI PENA
Title or Position: PRESIDENT
Credential:
Phone: 786-333-0376