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General NPI Number Information
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NPI Number | 1649941725
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Entity Type | Organization
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Legal Business Name | ENVIZION THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 20535 NW 2ND AVE STE 204
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City | MIAMI
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State | FL
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Zip | 33169-2547
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Country | US
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Telephone | 321-344-4901
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Fax |
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Provider Business Mailing Address
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Address Line | 4651 BABCOCK ST NE STE 18
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City | PALM BAY
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State | FL
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Zip | 32905-2808
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Country | US
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Telephone | 321-344-4901
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | TAMARA HARRIS
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Credential |
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Telephone | 321-344-4901
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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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