Healthcare Provider Details

I. General information

NPI: 1003672874
Provider Name (Legal Business Name): PERMUY DIVERSITY INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 NW 146TH LN
MIAMI LAKES FL
33018-8054
US

IV. Provider business mailing address

8760 NW 146TH LN
MIAMI LAKES FL
33018-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-238-5931
  • Fax:
Mailing address:
  • Phone: 786-238-5931
  • 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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LUIS D PERMUY
Title or Position: OWNER
Credential: LMHC-QS
Phone: 786-238-5931