Provider Demographics
NPI:1881275071
Name:BEHAVIOR & MENTAL HOPE INC
Entity type:Organization
Organization Name:BEHAVIOR & MENTAL HOPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-848-7091
Mailing Address - Street 1:17670 NW 78TH AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3665
Mailing Address - Country:US
Mailing Address - Phone:786-848-7091
Mailing Address - Fax:
Practice Address - Street 1:17670 NW 78TH AVE STE 114
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3665
Practice Address - Country:US
Practice Address - Phone:786-848-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLICENSEOther2021038322