Healthcare Provider Details

I. General information

NPI: 1053815316
Provider Name (Legal Business Name): GUIDED PATHS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13550 N KENDALL DR STE 270C
MIAMI FL
33186-1513
US

IV. Provider business mailing address

15000 SW 149TH AVE
MIAMI FL
33196-4416
US

V. Phone/Fax

Practice location:
  • Phone: 305-989-0493
  • Fax:
Mailing address:
  • Phone: 305-989-0493
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA B. DIEPPA
Title or Position: PRESIDENT
Credential: LMHC
Phone: 305-989-0493