Provider Demographics
NPI:1932635125
Name:H.E.A.L. PSYCHOTHERAPY SERVICES LLC
Entity Type:Organization
Organization Name:H.E.A.L. PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-749-2275
Mailing Address - Street 1:1 ALHAMBRA PLZ PH FLOOR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5216
Mailing Address - Country:US
Mailing Address - Phone:786-749-2275
Mailing Address - Fax:
Practice Address - Street 1:1 ALHAMBRA PLZ PH FLOOR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5216
Practice Address - Country:US
Practice Address - Phone:786-749-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-07
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty