Healthcare Provider Details

I. General information

NPI: 1477741551
Provider Name (Legal Business Name): JESSICA PUJALS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NW 36TH ST SUITE 102
VIRGINIA GARDENS FL
33166-6959
US

IV. Provider business mailing address

6501 NW 36TH ST SUITE #102
VIRGINIA GARDENS FL
33166-6959
US

V. Phone/Fax

Practice location:
  • Phone: 305-871-3131
  • Fax: 305-871-2727
Mailing address:
  • Phone: 305-871-3131
  • Fax: 305-871-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: