Healthcare Provider Details

I. General information

NPI: 1295428811
Provider Name (Legal Business Name): DIANA AMQUY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 SW 38 TER
MIAMI FL
33165
US

IV. Provider business mailing address

10141 SW 38TH TER
MIAMI FL
33165-3941
US

V. Phone/Fax

Practice location:
  • Phone: 305-773-3742
  • Fax:
Mailing address:
  • Phone: 305-773-3742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: