MEDICARE: CENTERPOINTE COUNSELING AND RECOVERY OF SARASOTA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023484300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERPOINTE COUNSELING AND RECOVERY OF SARASOTA

Provider Business Mailing Address
First Line	:	425 COMMMERCIAL CT
Second Line	:	SUITE100
City	:	VENICE
State	:	FL
Zip	:	34292
Country	:	US
Telephone Number	:	941-488-4811
Fax Number	:	941-488-4899

Provider Business Practice Location Address
First Line	:	5632 BEE RIDGE RD
Second Line	:	UNIT101
City	:	SARASOTA
State	:	FL
Zip	:	34233-1556
Country	:	US
Telephone Number	:	941-488-4811
Fax Number	:	941-488-4899

Authorized Official
Title or Position	:	THERAPST /OWNER
Name	:	CARRIE LYNN PHELPS
Credential	:	LMHC, CAP
Telephone Number	:	941-488-4811

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	08/25/2015

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