=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841995313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANDRA ORTIZ LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2023
-----------------------------------------------------
Last Update Date | 04/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11200 BISCAYNE BLVD PH 29
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-3467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 178-647-0911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11200 BISCAYNE BLVD PH 29
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-3467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 178-647-0911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH21995.
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------