Healthcare Provider Details

I. General information

NPI: 1568285260
Provider Name (Legal Business Name): MIAMI MENTAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2024
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S DIXIE HWY STE 104
MIAMI FL
33133-2455
US

IV. Provider business mailing address

2000 S DIXIE HWY STE 104
MIAMI FL
33133-2455
US

V. Phone/Fax

Practice location:
  • Phone: 786-390-2939
  • Fax:
Mailing address:
  • Phone: 786-390-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. FELIPE REGUEIRA
Title or Position: MENTAL HEALTH CLINICIAN/OWNER
Credential: LMHC
Phone: 786-390-2939