Healthcare Provider Details

I. General information

NPI: 1487137915
Provider Name (Legal Business Name): ADVANCED BEHAVIORAL & COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 107TH AVE
MIAMI FL
33165-2470
US

IV. Provider business mailing address

2500 SW 107TH AVE
MIAMI FL
33165-2470
US

V. Phone/Fax

Practice location:
  • Phone: 786-918-2924
  • Fax:
Mailing address:
  • Phone:
  • 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 Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LISSETTE GOMEZ
Title or Position: OWNER
Credential:
Phone: 786-918-2924