=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912562851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | Y & M BEHAVIORAL THERAPY SVC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2019
-----------------------------------------------------
Last Update Date | 08/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7900 OAK LN STE 400
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-5888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-622-5743
-----------------------------------------------------
Fax | 786-456-5001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7900 OAK LN STE 400
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-5888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-622-5743
-----------------------------------------------------
Fax | 786-456-5001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | YENEY GARCIA
-----------------------------------------------------
Credential | LMHC, BCBA
-----------------------------------------------------
Telephone | 786-622-5743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------