Provider Demographics
NPI:1578203089
Name:SELENITE ENTERPRISE LLC
Entity Type:Organization
Organization Name:SELENITE ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:YVANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-531-2340
Mailing Address - Street 1:51 NW 190TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4026
Mailing Address - Country:US
Mailing Address - Phone:786-531-2340
Mailing Address - Fax:
Practice Address - Street 1:1200 BRICKELL AVE STE 1950
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3298
Practice Address - Country:US
Practice Address - Phone:407-584-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health