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General NPI Number Information
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NPI Number | 1558844522
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL & COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 2500 SW 107TH AVE STE 42
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City | MIAMI
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State | FL
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Zip | 33165-2492
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Country | US
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Telephone | 786-615-3334
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Fax | 786-615-3257
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Provider Business Mailing Address
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Address Line | 2500 SW 107TH AVE STE 42
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City | MIAMI
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State | FL
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Zip | 33165-2492
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Country | US
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Telephone | 786-615-3334
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Fax | 786-615-3257
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISSETTE GOMEZ
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Credential | PHD
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Telephone | 786-918-2924
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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 |
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License Number State |
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