Healthcare Provider Details

I. General information

NPI: 1235728429
Provider Name (Legal Business Name): GM BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 NW 134TH PL
MIAMI FL
33182-2279
US

IV. Provider business mailing address

1182 NW 134TH PL
MIAMI FL
33182-2279
US

V. Phone/Fax

Practice location:
  • Phone: 786-763-5493
  • Fax:
Mailing address:
  • Phone: 786-763-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AYLEN GARCIA MORALES
Title or Position: PRESIDENT
Credential:
Phone: 786-763-5493