Healthcare Provider Details

I. General information

NPI: 1770930299
Provider Name (Legal Business Name): MENTAL HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 N FLAMINGO RD STE 347
PEMBROKE PINES FL
33028-1040
US

IV. Provider business mailing address

1620 NW 143RD TER
PEMBROKE PINES FL
33028-3002
US

V. Phone/Fax

Practice location:
  • Phone: 954-288-7362
  • Fax:
Mailing address:
  • Phone: 954-661-3672
  • Fax: 954-827-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH4696
License Number StateFL

VIII. Authorized Official

Name: DORA M SANTOS
Title or Position: PRESIDENT
Credential: LMHC
Phone: 954-288-7362