Provider Demographics
NPI:1659888352
Name:MIAMI LAKES BEHAVIORAL SERVICES CORP
Entity Type:Organization
Organization Name:MIAMI LAKES BEHAVIORAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD , LMHC
Authorized Official - Phone:786-423-4612
Mailing Address - Street 1:6001 NW 153RD ST STE 157
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2447
Mailing Address - Country:US
Mailing Address - Phone:786-907-4921
Mailing Address - Fax:
Practice Address - Street 1:6001 NW 153RD ST STE 157
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2447
Practice Address - Country:US
Practice Address - Phone:786-907-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10092101YM0800X, 103K00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty