# ENERGY COMMUNITY MENTAL HEALTH CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295310514
- **Authorized official:** ERNESTO RODRIGUEZ TANQUERO (PRESIDENT)
- **Authorized official phone:** (786) 227-2966

## Contact information

- **Practice address:** 4995 NW 72ND AVE STE 102, MIAMI, FL 33166-5643
- **Practice address phone:** (786) 227-2966
- **Mailing address:** 4995 NW 72ND AVE STE 102, MIAMI, FL 33166-5643
- **Mailing address phone:** (786) 227-2966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/17/2021
- **Last updated:** 11/21/2023