MEDICARE: LIFESTAR MENTAL WELLNESS CENTER INC, CMHC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619313186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTAR MENTAL WELLNESS CENTER INC, CMHC

Provider Business Mailing Address
First Line	:	3416 W 84TH ST STE 108
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4935
Country	:	US
Telephone Number	:	786-303-5079
Fax Number	:	786-442-2176

Provider Business Practice Location Address
First Line	:	3416 W 84TH ST STE 108
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-4935
Country	:	US
Telephone Number	:	305-557-1555
Fax Number	:	786-442-2176

Authorized Official
Title or Position	:	CEO/CFO
Name	:	MS. JENNY A BERNAL
Credential	:	RMHCI
Telephone Number	:	786-303-5079

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	01/13/2026

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