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General NPI Number Information
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NPI Number | 1932635125
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Entity Type | Organization
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Legal Business Name | H.E.A.L. PSYCHOTHERAPY SERVICES LLC
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Dates
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Enumeration Date | 05/07/2017
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Last Update Date | 03/20/2022
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Provider Practice Location Address
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Address Line | 1 ALHAMBRA PLZ PH FLOOR
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City | CORAL GABLES
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State | FL
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Zip | 33134-5216
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Country | US
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Telephone | 786-749-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ALHAMBRA PLZ PH FLOOR
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City | CORAL GABLES
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State | FL
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Zip | 33134-5216
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Country | US
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Telephone | 786-749-2275
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MS. MICHELLE C LAKE
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Credential | LMHC
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Telephone | 786-749-2275
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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 | MH 10806
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License Number State | FL
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