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General NPI Number Information
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NPI Number | 1417622689
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Entity Type | Organization
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Legal Business Name | HAZEL BEHAVIOR HEALTH INC
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Dates
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Enumeration Date | 08/10/2021
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 569 HAZEL ST
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City | KEY LARGO
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State | FL
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Zip | 33037-3125
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Country | US
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Telephone | 305-439-4877
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Fax |
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Provider Business Mailing Address
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Address Line | 569 HAZEL ST
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City | KEY LARGO
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State | FL
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Zip | 33037-3125
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Country | US
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Telephone | 305-439-4877
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIRELYS VALDES
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Credential |
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Telephone | 305-439-4877
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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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