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General NPI Number Information
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NPI Number | 1356654859
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Entity Type | Organization
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Legal Business Name | MEMBERSHIP THERAPY CENTER, C.M.H.C., INC.
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 10680 SW 186TH ST STE 36
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City | CUTLER BAY
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State | FL
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Zip | 33157-6720
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Country | US
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Telephone | 305-969-9448
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Fax | 305-969-9748
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Provider Business Mailing Address
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Address Line | 10680 SW 186TH ST STE 36
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City | CUTLER BAY
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State | FL
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Zip | 33157-6720
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Country | US
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Telephone | 305-969-9448
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Fax | 305-969-9748
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Authorized Official
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Title or Position | OFFICE MANAGER /REGISTERED AGENT
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Name | MRS. DORCAS IRIS DE JESUS
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Credential | MS STUDENT
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Telephone | 786-413-8487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH4025
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License Number State | FL
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