Healthcare Provider Details

I. General information

NPI: 1750168258
Provider Name (Legal Business Name): RESILIENCE AND COGNITIVE BEHAVIOR THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 NE 2ND AVE
MIAMI SHORES FL
33161-6628
US

IV. Provider business mailing address

7601 E TREASURE DR APT 2117
NORTH BAY VILLAGE FL
33141-4369
US

V. Phone/Fax

Practice location:
  • Phone: 504-388-5981
  • Fax:
Mailing address:
  • Phone: 504-388-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSE RAUL MACHUCA
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 504-388-5981