=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134538754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KNOWLEDGEABLE COUNSELOR PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2014
-----------------------------------------------------
Last Update Date | 08/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7850 NW 146TH ST STE 417
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-487-3948
-----------------------------------------------------
Fax | 305-556-4596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7850 NW 146TH ST STE 417
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-487-3948
-----------------------------------------------------
Fax | 305-556-4596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GLENDER DE JESUS CURRAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-487-3948
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | MH10549
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------