Healthcare Provider Details

I. General information

NPI: 1659794998
Provider Name (Legal Business Name): MARIA LUISA GONZALEZ IBARRA II LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12958 SW 133RD CT
MIAMI FL
33186-6169
US

IV. Provider business mailing address

13761 SW 72ND TER
MIAMI FL
33183-3119
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-5578
  • Fax:
Mailing address:
  • Phone: 786-444-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15985
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberMH15985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: