MEDICARE: BREATHE HOPE 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1124837026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE HOPE COUNSELING LLC

Provider Business Mailing Address
First Line	:	238 N MASSACHUSETTS AVE FL 1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4987
Country	:	US
Telephone Number	:	863-223-3995
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 N MASSACHUSETTS AVE FL 1
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4987
Country	:	US
Telephone Number	:	863-223-3995
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. REBECCA LYNN GRAY
Credential	:	LMHC
Telephone Number	:	863-223-3995

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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