Provider Demographics
NPI:1740013267
Name:MARIPOSA COUNSELING SERVICES
Entity type:Organization
Organization Name:MARIPOSA COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLOA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CBT
Authorized Official - Phone:954-702-3042
Mailing Address - Street 1:4801 S UNIVERSITY DR STE 219
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3837
Mailing Address - Country:US
Mailing Address - Phone:954-702-3042
Mailing Address - Fax:
Practice Address - Street 1:4801 S UNIVERSITY DR STE 219
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3837
Practice Address - Country:US
Practice Address - Phone:954-702-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIPOSA COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty