Healthcare Provider Details

I. General information

NPI: 1235612490
Provider Name (Legal Business Name): MARIA ANGELICA MEJIA PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 174TH ST APT L03
SUNNY ISLES BEACH FL
33160-3324
US

IV. Provider business mailing address

230 174TH ST APT L03
SUNNY ISLES BEACH FL
33160-3324
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-4167
  • Fax:
Mailing address:
  • Phone: 305-742-4167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: