Basic Information
| Provider Information | |||||||||
| NPI: | 1992152045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL FAMILY SOLUTIONS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8785 SW 165TH AVE | ||||||||
| Address2: | 106C | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331935826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863262888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8785 SW 165TH AVE | ||||||||
| Address2: | 106C | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331935826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863262888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2016 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | SAYLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7863262888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW12880 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251S00000X | SW12880 | FL | N | Agencies | Community/Behavioral Health | 261QD1600X | SW12880 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 624406 | 05 | FL | MEDICAID |