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General NPI Number Information
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NPI Number | 1467609388
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Entity Type | Organization
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Legal Business Name | PHOENIX CENTER FOR HEALING P.A.
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 11060 N KENDALL DR SUITE 7
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City | MIAMI
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State | FL
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Zip | 33176-1272
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Country | US
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Telephone | 305-345-3498
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Fax | 305-257-0040
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Provider Business Mailing Address
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Address Line | 14875 SW 238TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33032-8702
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Country | US
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Telephone | 786-236-7927
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Fax | 305-257-0040
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Authorized Official
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Title or Position | REGISTER AGENT FLORIDA CORP
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Name | MR. ROBERT HAFNER
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Credential | MENTAL HEALTH COUNSE
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Telephone | 786-236-7927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP 2344
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SS888
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License Number State | FL
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7474
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License Number State | FL
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