=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184071060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MHB CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2016
-----------------------------------------------------
Last Update Date | 05/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7855 NW 12TH ST 117
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-742-2189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9811 W OKEECHOBEE RD APT 210
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-2188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-548-7228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BEHAVIOR ASSISTSNT
-----------------------------------------------------
Name | MRS. MORAIMA ALFONSO
-----------------------------------------------------
Credential | RBT
-----------------------------------------------------
Telephone | 786-548-7228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | RBT-15-05298
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------