Provider Demographics
NPI:1154099455
Name:M.I.S MENTAL HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:M.I.S MENTAL HEALTH SERVICES CORP
Other - Org Name:M.I.S MENTAL HEALTH SERVICES CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAY TEJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:CBHCMS
Authorized Official - Phone:305-562-4396
Mailing Address - Street 1:5080 NW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5554
Mailing Address - Country:US
Mailing Address - Phone:305-562-4396
Mailing Address - Fax:305-631-2180
Practice Address - Street 1:5080 NW 74TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-5554
Practice Address - Country:US
Practice Address - Phone:305-562-4396
Practice Address - Fax:305-631-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)