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Organization
ENERGY COMMUNITY MENTAL HEALTH CLINIC LLC
Active
Organization
ENERGY COMMUNITY MENTAL HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO RODRIGUEZ TANQUERO (AUTHORIZED OFFICIAL)
(786) 520-0140
Entity
Organization
Contact information
Practice address
4995 NW 72ND AVE, MIAMI, FL 33166-5643
(786) 360-3584
(786) 360-3867
Mailing address
4995 NW 72ND AVE, MIAMI, FL 33166-5643
(786) 360-3584
(786) 360-3867
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112486800
—
FL
Enumeration date
12/27/2021
Last updated
12/27/2021
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