Provider Demographics
NPI:1336675917
Name:PONCE, JAVIER ENRIQUE (MS, RMHCI, RMFTI)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:ENRIQUE
Last Name:PONCE
Suffix:
Gender:M
Credentials:MS, RMHCI, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7203 NW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5522
Mailing Address - Country:US
Mailing Address - Phone:954-651-1523
Mailing Address - Fax:
Practice Address - Street 1:8400 N UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1752
Practice Address - Country:US
Practice Address - Phone:954-651-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15904101YM0800X
FLIMT2705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist