Provider Demographics
NPI:1134538754
Name:KNOWLEDGEABLE COUNSELOR PA
Entity type:Organization
Organization Name:KNOWLEDGEABLE COUNSELOR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENDER
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:CURRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-487-3948
Mailing Address - Street 1:7850 NW 146TH ST
Mailing Address - Street 2:STE 417
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1564
Mailing Address - Country:US
Mailing Address - Phone:786-487-3948
Mailing Address - Fax:305-556-4596
Practice Address - Street 1:7850 NW 146TH ST
Practice Address - Street 2:STE 417
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1564
Practice Address - Country:US
Practice Address - Phone:786-487-3948
Practice Address - Fax:305-556-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10549101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4408700Medicaid