=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649501909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PJ PSYCHOTHERAPY,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2010
-----------------------------------------------------
Last Update Date | 11/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9010 SW 137 AVE SUITE 209
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-388-2988
-----------------------------------------------------
Fax | 305-388-2949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9010 SW 137 AVE SUITE 209
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-1437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-388-2988
-----------------------------------------------------
Fax | 305-388-2949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PEDRO JULIO GARCIA
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 305-388-2988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------