MEDICARE: ELITE PSYCHOTHERAPY

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	302R00000X	Health Maintenance Organization	MH 9234	FL

General Provider Information

NPI Number	:	1295050292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	8785 SW 165TH AVE. SUITE 2016
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8785 SW 165TH AVE STE 2016
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5826
Country	:	US
Telephone Number	:	305-310-9818
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	MRS. VIVETTE FLORES
Credential	:	L.M.H.C
Telephone Number	:	305-310-9818

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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Directions to “ELITE PSYCHOTHERAPY ” Practice Location

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