Healthcare Provider Details

I. General information

NPI: 1033750815
Provider Name (Legal Business Name): BETH YEGELWEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 NW 7TH AVE
MIAMI FL
33136-1415
US

IV. Provider business mailing address

1603 NW 7TH AVE
MIAMI FL
33136-1415
US

V. Phone/Fax

Practice location:
  • Phone: 305-374-1065
  • Fax:
Mailing address:
  • Phone: 305-374-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH13274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: