Provider Demographics
NPI:1558844522
Name:ADVANCED BEHAVIORAL & COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL & COUNSELING SERVICES, LLC
Other - Org Name:ADVANCED BEHAVIORAL & COUNSELING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:786-918-2924
Mailing Address - Street 1:2500 SW 107TH AVE STE 42
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2492
Mailing Address - Country:US
Mailing Address - Phone:786-615-3334
Mailing Address - Fax:786-615-3257
Practice Address - Street 1:2500 SW 107TH AVE STE 42
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2492
Practice Address - Country:US
Practice Address - Phone:786-615-3334
Practice Address - Fax:786-615-3257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty