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General NPI Number Information
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NPI Number | 1457468381
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Entity Type | Individual
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Provider Name | LEONEL E MESA JR. PSY.D. LMHC
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 5753 MIAMI LAKES DR E
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2417
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Country | US
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Telephone | 305-403-0006
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Fax | 305-403-0007
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Provider Business Mailing Address
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Address Line | 7314 SABAL DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2523
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Country | US
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Telephone | 305-512-0566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4159
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License Number State | FL
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