MEDICARE: GUIDED INSIGHT PSYCHOLOGY LLC

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

General Provider Information

NPI Number	:	1407672561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDED INSIGHT PSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	67 NW 183RD ST STE 105
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4516
Country	:	US
Telephone Number	:	786-860-2468
Fax Number	:	305-863-4233

Provider Business Practice Location Address
First Line	:	67 NW 183RD ST STE 105
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-4516
Country	:	US
Telephone Number	:	786-860-2468
Fax Number	:	305-863-4233

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BETHANIA CARRION
Credential	:	PSY.D.
Telephone Number	:	786-860-2468

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	11/22/2024

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