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General NPI Number Information
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NPI Number | 1508300708
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Entity Type | Organization
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Legal Business Name | HOREB HEALTH CLINIC
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 911 NE 139TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-3252
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Country | US
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Telephone | 305-967-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 911 NE 139TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-3252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSE
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Name | MR. WEEDNY ANDRE
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Credential | M.S.
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Telephone | 305-967-9764
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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 | MH14215
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License Number State | FL
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