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General NPI Number Information
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NPI Number | 1265164420
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Entity Type | Organization
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Legal Business Name | HEALING THERAPEUTIC PRACTICE, LLC
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 04/09/2023
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Provider Practice Location Address
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Address Line | 15250 SW 154TH AVE
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City | MIAMI
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State | FL
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Zip | 33187-5437
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Country | US
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Telephone | 305-788-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 15250 SW 154TH AVE
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City | MIAMI
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State | FL
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Zip | 33187-5437
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Country | US
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Telephone | 305-788-2491
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JINELL NELLIE GONZALEZ
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Credential | BCBA, LMHC
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Telephone | 305-788-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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