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General NPI Number Information
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NPI Number | 1164967204
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Entity Type | Organization
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Legal Business Name | BLUE LINE COUNSELING
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 7600 SW 57TH AVE #225
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-916-6665
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 SW 148TH TER
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City | MIAMI
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State | FL
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Zip | 33176-7848
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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 | LMHC/DIRECTOR
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Name | MELISSA BAROSELA
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Credential |
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Telephone | 305-916-6665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH10663
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License Number State | FL
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