Healthcare Provider Details

I. General information

NPI: 1679133680
Provider Name (Legal Business Name): CARLOS ESCANILLA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 SW 32ND ST
MIAMI FL
33155-2437
US

IV. Provider business mailing address

8210 SW 32ND ST
MIAMI FL
33155-2437
US

V. Phone/Fax

Practice location:
  • Phone: 786-999-9520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: