Provider Demographics
NPI:1558532564
Name:AMIN PSYCHOLOGICAL HEALING AND LIFE ENHANCEMENT
Entity Type:Organization
Organization Name:AMIN PSYCHOLOGICAL HEALING AND LIFE ENHANCEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:KALHOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSY-D
Authorized Official - Phone:954-732-1103
Mailing Address - Street 1:1431 N.W. 105 AVE.
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6602
Mailing Address - Country:US
Mailing Address - Phone:954-732-1103
Mailing Address - Fax:954-474-5851
Practice Address - Street 1:300 S. PINE ISLAND RD. SUITE # 211
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2620
Practice Address - Country:US
Practice Address - Phone:954-732-1103
Practice Address - Fax:954-474-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6582261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1174688063Medicare PIN