Provider Demographics
NPI:1508213570
Name:MHB CONSULTANT
Entity Type:Organization
Organization Name:MHB CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.B.T
Authorized Official - Prefix:DR
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:786-346-7605
Mailing Address - Street 1:235 W 56TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7855 NW 12TH ST # 117
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1826
Practice Address - Country:US
Practice Address - Phone:305-742-2198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-01490251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL090268Medicaid