Provider Demographics
NPI:1649732710
Name:ANTIAN MENTAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:ANTIAN MENTAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAIDEMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-800-4759
Mailing Address - Street 1:15125 SW 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-6314
Mailing Address - Country:US
Mailing Address - Phone:786-800-4759
Mailing Address - Fax:
Practice Address - Street 1:13335 SW 124TH ST STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7515
Practice Address - Country:US
Practice Address - Phone:786-800-4759
Practice Address - Fax:786-527-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty