MEDICARE: ORANGE AVENUE CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003277971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE AVENUE CONSULTING

Provider Business Mailing Address
First Line	:	9344 LAKE FISCHER BLVD
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5203
Country	:	US
Telephone Number	:	812-483-4775
Fax Number	:

Provider Business Practice Location Address
First Line	:	9344 LAKE FISCHER BLVD
Second Line	:
City	:	GOTHA
State	:	FL
Zip	:	34734-5203
Country	:	US
Telephone Number	:	812-483-4775
Fax Number	:

Authorized Official
Title or Position	:	REG. MENTAL HEALTH COUNSELOR INTERN
Name	:	MRS. NATALEE RHODES SUMMERS
Credential	:
Telephone Number	:	812-483-4775

Provider Enumeration Date	:	03/18/2016
Last Update Date	:	03/18/2016

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Directions to “ORANGE AVENUE CONSULTING ” Practice Location

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