Healthcare Provider Details

I. General information

NPI: 1467733048
Provider Name (Legal Business Name): JOSE BTESH LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SANS SOUCI BLVD C 1502
NORTH MIAMI FL
33181-3045
US

IV. Provider business mailing address

2150 SANS SOUCI BLVD C 1502
NORTH MIAMI FL
33181-3045
US

V. Phone/Fax

Practice location:
  • Phone: 786-447-0395
  • Fax:
Mailing address:
  • Phone: 786-447-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: