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General NPI Number Information
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NPI Number | 1164664868
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Entity Type | Individual
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Provider Name | JOSE RAUL MACHUCA PHD., LMHC
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Gender | Male
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 9822 NE 2ND AVE STE 2
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2347
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Country | US
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Telephone | 985-326-9258
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Fax |
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Provider Business Mailing Address
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Address Line | 9822 NE 2ND AVE STE 2
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2347
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Country | US
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Telephone | 985-326-9258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MH12212
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License Number State | FL
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