Healthcare Provider Details

I. General information

NPI: 1922415504
Provider Name (Legal Business Name): JULIAN ENRIQUE VIVES M.S., NCC, RMHCI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NW 59TH ST
MIAMI FL
33127-1218
US

IV. Provider business mailing address

6100 BLUE LAGOON DR SUITE 400
MIAMI FL
33126-2079
US

V. Phone/Fax

Practice location:
  • Phone: 305-759-8888
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • 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:
Title or Position:
Credential:
Phone: