Provider Demographics
NPI:1013468008
Name:LIGHT OF HOPE BEHAVIOR THERAPY INC
Entity Type:Organization
Organization Name:LIGHT OF HOPE BEHAVIOR THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:I
Authorized Official - Credentials:IMH
Authorized Official - Phone:786-450-8836
Mailing Address - Street 1:15190 SW 136TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2618
Mailing Address - Country:US
Mailing Address - Phone:786-701-3109
Mailing Address - Fax:
Practice Address - Street 1:15190 SW 136TH ST STE 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-2618
Practice Address - Country:US
Practice Address - Phone:786-701-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13325101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherBEHAVIOR THERAPY