Healthcare Provider Details

I. General information

NPI: 1669839171
Provider Name (Legal Business Name): GLENN CESAR PRIETO LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15997 SW 54TH TER
MIAMI FL
33185-5027
US

IV. Provider business mailing address

15760 SW 69TH LN
MIAMI FL
33193-5506
US

V. Phone/Fax

Practice location:
  • Phone: 305-439-9434
  • Fax:
Mailing address:
  • Phone: 305-439-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH9508
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: