Healthcare Provider Details

I. General information

NPI: 1982914461
Provider Name (Legal Business Name): MIAMI INSTITUTE OF TRAINING AND NEUROFEEDBACK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 SW 37TH AVE SUITE 505
MIAMI FL
33133-2754
US

IV. Provider business mailing address

2645 SW 37 AVENUE SUITE 505
MIAMI FL
33133-2754
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-5111
  • Fax:
Mailing address:
  • Phone: 305-448-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberSW 4950
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSW 4950
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW 4950
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 4950
License Number StateFL

VIII. Authorized Official

Name: MR. WILLIAM MUSTELIER
Title or Position: CEO/PRESIDENT
Credential: LCSW
Phone: 305-448-5111