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NPI Code Detail

MEDICARE: FOOTPRINTS COUNSELING LLC

MEDICARE: FOOTPRINTS 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
1101YM0800XMental Health CounselorMH13279FL

General Provider Information

NPI Number : 1033657036
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOTPRINTS COUNSELING LLC
Provider Business Mailing Address
First Line : 7221 16TH CT NE
Second Line :
City : SAINT PETERSBURG
State : FL
Zip : 33702-4605
Country : US
Telephone Number : 727-458-1080
Fax Number :
Provider Business Practice Location Address
First Line : 275 4TH ST N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33701-3205
Country : US
Telephone Number : 727-828-8361
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DEBRA M KRAUS
Credential : LMHC
Telephone Number : 727-458-1080
Provider Enumeration Date : 02/09/2017
Last Update Date : 02/09/2017

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Directions to “FOOTPRINTS COUNSELING LLC ” Practice Location

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