Healthcare Provider Details

I. General information

NPI: 1881646537
Provider Name (Legal Business Name): HECTOR VALLES LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12515 N KENDALL DR STE 200
MIAMI FL
33138
US

IV. Provider business mailing address

1065 NE 125 ST STE 409
NORTH MIAMI FL
33161
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: