MEDICARE: CORAL CONSUELO SECO LMHC

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	101YM0800X	Mental Health Counselor	MH15921	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	861270	OTHER	FL	MENTAL HEALTH

General Provider Information

NPI Number	:	1639668106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAL CONSUELO SECO LMHC

Provider Business Mailing Address
First Line	:	9350 SW 72ND ST STE 175
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3292
Country	:	US
Telephone Number	:	786-714-4723
Fax Number	:

Provider Business Practice Location Address
First Line	:	9350 SW 72ND ST STE 175
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3292
Country	:	US
Telephone Number	:	305-595-7378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	08/26/2019

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