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General NPI Number Information
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NPI Number | 1124381082
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Entity Type | Organization
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Legal Business Name | THRU A CHILD'S EYES PLAY THERAPY AND FAMILY ENRICHMENT CENTER
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 27535 S DIXIE HWY
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City | HOMESTEAD
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State | FL
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Zip | 33032-8225
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Country | US
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Telephone | 786-592-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 1711 W 38TH PL 1207
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City | HIALEAH
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State | FL
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Zip | 33012-7077
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Country | US
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Telephone | 786-592-0940
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LAURA R ORTEGA
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Credential | LMFT
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Telephone | 786-592-0940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MT 2451
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License Number State | FL
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