Healthcare Provider Details

I. General information

NPI: 1073185864
Provider Name (Legal Business Name): GRETTEL CARBALLO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 NW 166TH ST
MIAMI LAKES FL
33016-3421
US

IV. Provider business mailing address

8001 NW 166TH ST
MIAMI LAKES FL
33016-3421
US

V. Phone/Fax

Practice location:
  • Phone: 786-427-3710
  • Fax:
Mailing address:
  • Phone: 786-427-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76451
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH19055
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: