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General NPI Number Information
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NPI Number | 1710663646
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL HEALTH CONSULTS , LLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 3350 SW 148 AVE 110
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 786-541-5472
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 SW 148 AVE 110
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 786-541-5472
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Fax |
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Authorized Official
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Title or Position | OFFICE
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Name | MS. AFIA TYSON
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Credential | SOCIAL WORKER
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Telephone | 786-541-5472
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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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