=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851995807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PILLAR MIND AND BEHAVIOR, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2020
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 BISCAYNE BLVD APT 3406
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-1731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-332-4340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1172 S DIXIE HWY # 222
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LICENSED MENTAL HLTH COUNSELO
-----------------------------------------------------
Name | DR. KAYLA MARMAROS
-----------------------------------------------------
Credential | LMHC, PHD
-----------------------------------------------------
Telephone | 786-332-4340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------