MEDICARE: SEEDS OF HOPE BEHAVIORAL HEALTH, LLP

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	103TC0700X	Clinical Psychologist	PY 9410	FL
2	1041C0700X	Clinical Social Worker	SW 13260	FL
3	101YM0800X	Mental Health Counselor	MH14084	FL

General Provider Information

NPI Number	:	1346692159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEDS OF HOPE BEHAVIORAL HEALTH, LLP

Provider Business Mailing Address
First Line	:	2000 PONCE DE LEON BLVD
Second Line	:	SUITE: 605
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4422
Country	:	US
Telephone Number	:	305-421-6354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 PONCE DE LEON BLVD
Second Line	:	SUITE: 605
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4422
Country	:	US
Telephone Number	:	305-421-6354
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. ZULAYMIS MIGOYO
Credential	:	LMHC
Telephone Number	:	305-421-6354

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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