MEDICARE: VALLADARES THERAPY SERVICES & CONSULTATION, INC

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	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	:	1679925051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLADARES THERAPY SERVICES & CONSULTATION, INC

Provider Business Mailing Address
First Line	:	14956 SW 60TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-2059
Country	:	US
Telephone Number	:	305-281-1927
Fax Number	:	305-397-1273

Provider Business Practice Location Address
First Line	:	14335 SW 120TH ST STE 108
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-7295
Country	:	US
Telephone Number	:	305-281-1927
Fax Number	:	305-397-1273

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	AYMARA VALLADARES
Credential	:	LMHC
Telephone Number	:	305-281-1927

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	08/10/2021

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