Provider Demographics
NPI:1811215866
Name:MIAMI PSYCHOLOGY & HUMAN SERVICE COLLABORATIVE, INC
Entity Type:Organization
Organization Name:MIAMI PSYCHOLOGY & HUMAN SERVICE COLLABORATIVE, INC
Other - Org Name:MIAMI PSYCHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-741-5628
Mailing Address - Street 1:PO BOX 370333
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-0333
Mailing Address - Country:US
Mailing Address - Phone:305-741-5628
Mailing Address - Fax:305-397-1650
Practice Address - Street 1:8201 PETERS RD STE 1000
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3266
Practice Address - Country:US
Practice Address - Phone:305-741-5628
Practice Address - Fax:305-397-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
FLSW9577101YP1600X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty