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General NPI Number Information
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NPI Number | 1619688314
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Entity Type | Organization
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Legal Business Name | HEALTH AND HEALING MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 1599 SE LENNARD RD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-6542
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Country | US
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Telephone | 772-323-0762
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Fax |
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Provider Business Mailing Address
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Address Line | 1599 SE LENNARD RD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-6542
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Country | US
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Telephone | 772-323-0762
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MARLENE EGUSQUIZA
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Credential |
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Telephone | 786-210-5277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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