Provider Demographics
NPI:1891572699
Name:ST. HILAIRE, VENISE (MHI 21167)
Entity Type:Individual
Prefix:
First Name:VENISE
Middle Name:
Last Name:ST. HILAIRE
Suffix:
Gender:F
Credentials:MHI 21167
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROYAL PALM WAY
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-2716
Mailing Address - Country:US
Mailing Address - Phone:504-777-5892
Mailing Address - Fax:
Practice Address - Street 1:140 ROYAL PALM WAY
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2716
Practice Address - Country:US
Practice Address - Phone:504-777-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL21167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty