Provider Demographics
NPI:1467994657
Name:BALLESTEROS, CARY P (EDS LMHC RPT-S)
Entity Type:Individual
Prefix:MRS
First Name:CARY
Middle Name:P
Last Name:BALLESTEROS
Suffix:
Gender:F
Credentials:EDS LMHC RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12651 S DIXIE HWY STE 307
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5961
Mailing Address - Country:US
Mailing Address - Phone:305-233-4233
Mailing Address - Fax:
Practice Address - Street 1:12651 S DIXIE HWY STE 307
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-5961
Practice Address - Country:US
Practice Address - Phone:305-233-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-06
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5858101YM0800X
FLSS 517103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool