Healthcare Provider Details

I. General information

NPI: 1225748288
Provider Name (Legal Business Name): KELVN THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 SW 149TH AVE
MIAMI FL
33193-2480
US

IV. Provider business mailing address

5850 SW 149TH AVE
MIAMI FL
33193-2480
US

V. Phone/Fax

Practice location:
  • Phone: 305-439-4413
  • Fax: 786-454-4955
Mailing address:
  • Phone: 786-508-2778
  • Fax: 786-454-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXANDRA H SAAVEDRA
Title or Position: OFFICER
Credential: THERAPIST
Phone: 786-365-4834