Provider Demographics
NPI:1033650114
Name:MISSION COUNSELING GROUP, PLLC
Entity Type:Organization
Organization Name:MISSION COUNSELING GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:JEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, QS
Authorized Official - Phone:786-601-2608
Mailing Address - Street 1:PO BOX 700731
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-0731
Mailing Address - Country:US
Mailing Address - Phone:786-601-2608
Mailing Address - Fax:305-647-0250
Practice Address - Street 1:27501 S DIXIE HWY
Practice Address - Street 2:SUITE 403
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-8235
Practice Address - Country:US
Practice Address - Phone:786-601-2608
Practice Address - Fax:305-647-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty