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General NPI Number Information
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NPI Number | 1356680797
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Entity Type | Organization
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Legal Business Name | KRISTI HOUSE
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 18441 NW 2ND AVE SUITE 500
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City | MIAMI
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State | FL
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Zip | 33169-4517
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Country | US
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Telephone | 305-249-0521
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Fax |
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Provider Business Mailing Address
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Address Line | 18441 NW 2ND AVE SUITE 500
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City | MIAMI
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State | FL
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Zip | 33169-4517
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Country | US
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Telephone | 305-249-0521
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. TYISHA DERONETH
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Credential | LCSW
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Telephone | 305-249-0521
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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 | SW11065
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License Number State | FL
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