Provider Demographics
NPI:1386472470
Name:BEYOND THE GAZE THERAPY SERVICES
Entity type:Organization
Organization Name:BEYOND THE GAZE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUAMAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELL NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-280-9118
Mailing Address - Street 1:1550 MADRUGA AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3018
Mailing Address - Country:US
Mailing Address - Phone:786-280-9118
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE STE 311
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3066
Practice Address - Country:US
Practice Address - Phone:786-280-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty