Provider Demographics
NPI:1336965987
Name:KSM BEHAVIORAL INTERVENTIONS LLC
Entity type:Organization
Organization Name:KSM BEHAVIORAL INTERVENTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MILEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MCAP, CBHCMS
Authorized Official - Phone:786-970-6385
Mailing Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 508
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4846
Mailing Address - Country:US
Mailing Address - Phone:786-970-6385
Mailing Address - Fax:786-743-6385
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 508
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4846
Practice Address - Country:US
Practice Address - Phone:786-970-6385
Practice Address - Fax:786-743-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty