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NPI Code Detail

MEDICARE: MIAMI LAKES BEHAVIORAL SERVICES CORP

MEDICARE: MIAMI LAKES BEHAVIORAL SERVICES CORP
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
1252Y00000XEarly Intervention Provider AgencyMH10092FL
2251S00000XCommunity/Behavioral Health AgencyMH10092FL
3101YM0800XMental Health CounselorMH10092FL
4103K00000XBehavior AnalystMH10092FL

General Provider Information

NPI Number : 1659888352
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIAMI LAKES BEHAVIORAL SERVICES CORP
Provider Business Mailing Address
First Line : 6001 NW 153RD ST STE 157
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33014-2447
Country : US
Telephone Number : 786-907-4921
Fax Number :
Provider Business Practice Location Address
First Line : 6001 NW 153RD ST STE 157
Second Line :
City : MIAMI LAKES
State : FL
Zip : 33014-2447
Country : US
Telephone Number : 786-907-4921
Fax Number :
Authorized Official
Title or Position : PRESIDENT/CLINICAL DIRECTOR
Name : MAYLIN BATISTA
Credential : PH.D , LMHC
Telephone Number : 786-423-4612
Provider Enumeration Date : 01/03/2018
Last Update Date : 06/16/2018

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