MEDICARE: KRISTI HOUSE

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	251S00000X	Community/Behavioral Health Agency	SW11065	FL

General Provider Information

NPI Number	:	1356680797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTI HOUSE

Provider Business Mailing Address
First Line	:	18441 NW 2ND AVE
Second Line	:	SUITE 500
City	:	MIAMI
State	:	FL
Zip	:	33169-4517
Country	:	US
Telephone Number	:	305-249-0521
Fax Number	:

Provider Business Practice Location Address
First Line	:	18441 NW 2ND AVE
Second Line	:	SUITE 500
City	:	MIAMI
State	:	FL
Zip	:	33169-4517
Country	:	US
Telephone Number	:	305-249-0521
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. TYISHA DERONETH
Credential	:	LCSW
Telephone Number	:	305-249-0521

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	02/05/2013

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Directions to “KRISTI HOUSE ” Practice Location

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