Healthcare Provider Details

I. General information

NPI: 1245027457
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ESSENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25300 SW 115TH CT
HOMESTEAD FL
33032-4723
US

IV. Provider business mailing address

25300 SW 115TH CT
HOMESTEAD FL
33032-4723
US

V. Phone/Fax

Practice location:
  • Phone: 786-252-5774
  • Fax:
Mailing address:
  • Phone: 786-252-5774
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: YULIANIS FUNDORA
Title or Position: OWNER
Credential:
Phone: 786-252-5774