MEDICARE: THE SAILS INSTITUTE

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	101YM0800X	Mental Health Counselor	MH-12929	FL

General Provider Information

NPI Number	:	1285027334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SAILS INSTITUTE

Provider Business Mailing Address
First Line	:	600 NE 36TH ST
Second Line	:	APT 407
City	:	MIAMI
State	:	FL
Zip	:	33137-3929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 NE 36TH ST
Second Line	:	APT 407
City	:	MIAMI
State	:	FL
Zip	:	33137-3929
Country	:	US
Telephone Number	:	305-814-4863
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. DENISE FOURNIER
Credential	:	LMHC
Telephone Number	:	954-309-0834

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/13/2015

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