=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598932469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED MENTAL HEALTH SERVICES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2008
-----------------------------------------------------
Last Update Date | 10/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10031 PINES BLVD SUITE # 246
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-6179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-438-2172
-----------------------------------------------------
Fax | 954-438-2172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10031 PINES BLVD SUITE # 246
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33024-6179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-438-2172
-----------------------------------------------------
Fax | 954-438-2172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HECTOR RICARDO BERRIO
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 954-438-2172
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MH8207
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------