Provider Demographics
NPI:1639631047
Name:DYNASTY MENTAL HEALTH, INC
Entity Type:Organization
Organization Name:DYNASTY MENTAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-732-4331
Mailing Address - Street 1:12985 SW 130TH CT UNIT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5346
Mailing Address - Country:US
Mailing Address - Phone:786-732-4331
Mailing Address - Fax:786-732-4338
Practice Address - Street 1:12985 SW 130TH CT UNIT 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5346
Practice Address - Country:US
Practice Address - Phone:786-732-4331
Practice Address - Fax:786-732-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)