Healthcare Provider Details

I. General information

NPI: 1932790177
Provider Name (Legal Business Name): MENDING HEARTS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 10/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 INVERRARY BLVD STE 404
LAUDERHILL FL
33319-4381
US

IV. Provider business mailing address

3810 INVERRARY BLVD
LAUDERHILL FL
33319
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-0713
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ESTHER GEORGES
Title or Position: OWNER
Credential: LCSW
Phone: 305-924-0713