Provider Demographics
NPI:1164801866
Name:SYSTEMIC WELLNESS
Entity Type:Organization
Organization Name:SYSTEMIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:786-436-1984
Mailing Address - Street 1:11025 SW 84TH ST
Mailing Address - Street 2:COTTAGE 12
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3857
Mailing Address - Country:US
Mailing Address - Phone:786-436-1984
Mailing Address - Fax:305-320-4001
Practice Address - Street 1:11025 SW 84TH ST
Practice Address - Street 2:COTTAGE 12
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3857
Practice Address - Country:US
Practice Address - Phone:786-436-1984
Practice Address - Fax:305-320-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management