=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619452083
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIELA CAMPOS LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2018
-----------------------------------------------------
Last Update Date | 10/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 651 W 20TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-301-3331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 453431
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33245-3431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-301-3331
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH16358
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------