Healthcare Provider Details

I. General information

NPI: 1902228141
Provider Name (Legal Business Name): 2000 THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 S DIXIE HWY SUITE 317
MIAMI FL
33156-5975
US

IV. Provider business mailing address

12651 S DIXIE HWY SUITE 317
MIAMI FL
33156-5975
US

V. Phone/Fax

Practice location:
  • Phone: 305-491-5223
  • Fax:
Mailing address:
  • Phone: 305-491-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 8795
License Number StateFL

VIII. Authorized Official

Name: DR. ODALYS J. WAUGH
Title or Position: MENTAL HEALTH COUNSELOR
Credential: PHD
Phone: 305-491-5223