Provider Demographics
NPI:1013538800
Name:NORTH MIAMI HOLISTIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:NORTH MIAMI HOLISTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-318-8732
Mailing Address - Street 1:14880 SW 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6275
Mailing Address - Country:US
Mailing Address - Phone:786-318-8732
Mailing Address - Fax:
Practice Address - Street 1:14880 SW 180TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-6275
Practice Address - Country:US
Practice Address - Phone:786-318-8732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health