MEDICARE: LIGHT OF HOPE BEHAVIOR THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1124987847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT OF HOPE BEHAVIOR THERAPY INC

Provider Business Mailing Address
First Line	:	15190 SW 136TH ST STE 4
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-2618
Country	:	US
Telephone Number	:	786-701-3109
Fax Number	:	305-747-7166

Provider Business Practice Location Address
First Line	:	14483 SW 172ND LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-6619
Country	:	US
Telephone Number	:	786-450-8836
Fax Number	:	305-747-7166

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TANIA H PEREZ GONZALEZ
Credential	:
Telephone Number	:	786-701-3109

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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