Healthcare Provider Details

I. General information

NPI: 1669830519
Provider Name (Legal Business Name): NIKAURY MUNOZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTHALL LN STE 207
MAITLAND FL
32751-7478
US

IV. Provider business mailing address

2700 WESTHALL LN STE 207
MAITLAND FL
32751-7478
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-3530
  • Fax:
Mailing address:
  • Phone: 407-636-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: