Healthcare Provider Details

I. General information

NPI: 1811215866
Provider Name (Legal Business Name): MIAMI PSYCHOLOGY & HUMAN SERVICE COLLABORATIVE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 PETERS RD STE 1000
PLANTATION FL
33324-3266
US

IV. Provider business mailing address

PO BOX 370333
MIAMI FL
33137-0333
US

V. Phone/Fax

Practice location:
  • Phone: 305-741-5628
  • Fax: 305-397-1650
Mailing address:
  • Phone: 305-741-5628
  • Fax: 305-397-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberSW9577
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9577
License Number StateFL

VIII. Authorized Official

Name: MISS NATASHA K NALLS
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 305-741-5628