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General NPI Number Information
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NPI Number | 1033650114
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Entity Type | Organization
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Legal Business Name | MISSION COUNSELING GROUP, PLLC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 27501 S DIXIE HWY SUITE 403
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City | NARANJA
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State | FL
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Zip | 33032-8235
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Country | US
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Telephone | 786-601-2608
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Fax | 305-647-0250
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Provider Business Mailing Address
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Address Line | PO BOX 700731
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City | MIAMI
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State | FL
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Zip | 33170-0731
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Country | US
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Telephone | 786-601-2608
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Fax | 305-647-0250
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SAMIR G JEREZ
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Credential | LMHC, QS
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Telephone | 786-601-2608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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