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General NPI Number Information
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NPI Number | 1427448315
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Entity Type | Organization
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Legal Business Name | WINGS OF A BUTTERFLY PC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 6001 NW 153RD ST STE 157
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2447
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Country | US
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Telephone | 305-924-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 14361 NW 87TH CT
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City | MIAMI LAKES
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State | FL
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Zip | 33018-8045
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Country | US
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Telephone | 305-924-3230
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. IDIANA MORALES
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Credential | LMHC
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Telephone | 305-924-3230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | MH9102
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License Number State | FL
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