Healthcare Provider Details

I. General information

NPI: 1174455687
Provider Name (Legal Business Name): BEST LIFE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 PRIMROSE LN
KINGS PARK NY
11754-3929
US

IV. Provider business mailing address

66 PRIMROSE LN
KINGS PARK NY
11754-3929
US

V. Phone/Fax

Practice location:
  • Phone: 631-748-7730
  • Fax: 631-748-7730
Mailing address:
  • Phone: 631-748-7730
  • Fax: 631-748-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. WENDELL MILLER
Title or Position: OWNER
Credential: LMSW, CBIST - PSYCHO
Phone: 631-748-7730