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General NPI Number Information
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NPI Number | 1154820926
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Entity Type | Organization
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Legal Business Name | HEALTHY MINDS HEALTHY HEARTS THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 11820 MIRAMAR PKWY STE 304
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City | MIRAMAR
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State | FL
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Zip | 33025-5820
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Country | US
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Telephone | 954-225-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 7958 PINES BLVD UNIT 324
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | LATHOSHA ALEXANDER
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Credential | LSCW
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Telephone | 954-445-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW14731
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License Number State | FL
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