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General NPI Number Information
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NPI Number | 1942789516
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Entity Type | Organization
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Legal Business Name | SHAPING LIVES BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 7600 S RED RD STE 208
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5408
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Country | US
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Telephone | 305-345-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 7742 N KENDALL DR # 422
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City | MIAMI
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State | FL
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Zip | 33156-7523
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Country | US
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Telephone | 786-598-7171
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS ORTIZ
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Credential |
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Telephone | 305-345-3751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH15356
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License Number State | FL
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