MEDICARE: ARISE COACHING AND THERAPEUTIC SERVICES

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

General Provider Information

NPI Number	:	1669291233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISE COACHING AND THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	3930 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6240
Country	:	US
Telephone Number	:	786-530-5410
Fax Number	:	786-530-5424

Provider Business Practice Location Address
First Line	:	3930 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33054-6240
Country	:	US
Telephone Number	:	786-530-5410
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. THALIA STEVENSON
Credential	:	MS
Telephone Number	:	786-530-5410

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	11/21/2024

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