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General NPI Number Information
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NPI Number | 1417628520
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Entity Type | Organization
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Legal Business Name | AUTONOMY HOUR
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 101 MAJORCA AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-4508
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Country | US
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Telephone | 786-618-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MAJORCA AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-4508
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Country | US
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Telephone | 786-618-2627
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Fax | 786-685-2126
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Authorized Official
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Title or Position | AMBR
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Name | MRS. BRITTANY L WALLIS
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Credential | LMFT
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Telephone | 786-618-2627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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