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General NPI Number Information
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NPI Number | 1962942920
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Entity Type | Organization
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Legal Business Name | INNER CONNECTIONS THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 2627 NE 203RD ST SUITE 214
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City | AVENTURA
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State | FL
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Zip | 33180-1900
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Country | US
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Telephone | 754-800-9540
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 NE 203RD ST SUITE 214
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City | AVENTURA
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State | FL
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Zip | 33180-1900
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Country | US
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Telephone | 754-800-9540
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/LMHC
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Name | MRS. TARA PASSARETTI
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Credential | LMHC
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Telephone | 754-800-9540
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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 | MH14552
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License Number State | FL
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