Healthcare Provider Details

I. General information

NPI: 1437092046
Provider Name (Legal Business Name): LC MENTAL HEALTH CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9299 SW 152ND ST STE 200
PALMETTO BAY FL
33157-1776
US

IV. Provider business mailing address

8207 NW 59TH PL
TAMARAC FL
33321-4214
US

V. Phone/Fax

Practice location:
  • Phone: 786-300-7704
  • Fax:
Mailing address:
  • Phone: 786-300-7704
  • Fax: 786-300-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: LUIS COLLAZO
Title or Position: PMHNP
Credential: APRN
Phone: 786-300-7704