=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750137071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOTIVATING LIVES MENTAL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2024
-----------------------------------------------------
Last Update Date | 07/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10300 SW 72ND ST STE 414
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-203-5379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27312 SW 138TH PATH
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-7797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-203-5379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JONACHY PRIETO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-203-5379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------