MEDICARE: REFINED BEGINNINGS COUNSELING, LLC

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	MH14724	FL

General Provider Information

NPI Number	:	1013456862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFINED BEGINNINGS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1301 RIVERPLACE BLVD
Second Line	:	SUITE 800
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9047
Country	:	US
Telephone Number	:	904-352-9460
Fax Number	:	904-562-1361

Provider Business Practice Location Address
First Line	:	1301 RIVERPLACE BLVD
Second Line	:	SUITE 800
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9047
Country	:	US
Telephone Number	:	904-352-9460
Fax Number	:	904-562-1361

Authorized Official
Title or Position	:	OWNER
Name	:	RENET'E BENJAMIN
Credential	:	LMHC
Telephone Number	:	904-352-9460

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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