Healthcare Provider Details

I. General information

NPI: 1659888352
Provider Name (Legal Business Name): MIAMI LAKES BEHAVIORAL SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NW 153RD ST STE 157
MIAMI LAKES FL
33014-2447
US

IV. Provider business mailing address

6001 NW 153RD ST STE 157
MIAMI LAKES FL
33014-2447
US

V. Phone/Fax

Practice location:
  • Phone: 786-907-4921
  • Fax:
Mailing address:
  • Phone: 786-907-4921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10092
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH10092
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH10092
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberMH10092
License Number StateFL

VIII. Authorized Official

Name: MAYLIN BATISTA
Title or Position: PRESIDENT/CLINICAL DIRECTOR
Credential: PH.D , LMHC
Phone: 786-423-4612