Healthcare Provider Details

I. General information

NPI: 1497212955
Provider Name (Legal Business Name): ALTIS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 MIRAMAR PKWY STE 304
MIRAMAR FL
33025-5820
US

IV. Provider business mailing address

PO BOX 772002
OCALA FL
34477-2002
US

V. Phone/Fax

Practice location:
  • Phone: 786-886-4631
  • Fax:
Mailing address:
  • Phone: 786-886-4631
  • Fax: 720-265-9580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. EVA ABAD
Title or Position: DIRECTOR
Credential: LMHC
Phone: 786-838-9568