Organization
BODHI TREE THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAKIRA VASQUEZ MOSCOSO LMHC (OWNER)
(202) 374-0573
Entity
Organization
Contact information
Practice address
5512 FAIRFAX ST, ORLANDO, FL 32812-7732
(202) 374-0573
Mailing address
5512 FAIRFAX ST, ORLANDO, FL 32812-7732
(202) 374-0573
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH17846
LICENSE
FL
Enumeration date
07/26/2022
Last updated
07/26/2022
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