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NPI Code Detail

MEDICARE: UPPER ROOM COUNSELING CENTER, INC.

MEDICARE: UPPER ROOM COUNSELING CENTER, INC.
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
1101Y00000XCounselorMH-4358FL
2101YA0400XAddiction (Substance Use Disorder) CounselorMH-4358FL
3101YP1600XPastoral CounselorMH-4358FL
4101YP2500XProfessional CounselorMH-4358FL
5102L00000XPsychoanalystMH-4358FL
6106H00000XMarriage & Family TherapistMH-4358FL
7101YM0800XMental Health CounselorMH-4358FL

General Provider Information

NPI Number : 1134439235
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPPER ROOM COUNSELING CENTER, INC.
Provider Business Mailing Address
First Line : 3420 HWY 441/27
Second Line :
City : FRUITLAND PARK
State : FL
Zip : 34731-4474
Country : US
Telephone Number : 352-435-4631
Fax Number : 352-435-4632
Provider Business Practice Location Address
First Line : 3420 HWY 27/441
Second Line :
City : FRUITLAND PARK
State : FL
Zip : 34731-4474
Country : US
Telephone Number : 352-435-4631
Fax Number : 352-435-4632
Authorized Official
Title or Position : DIRECTOR OF COUNSELING
Name : MR. JERRY FRANKLIN PHILLIPS
Credential : L.M.H.C.
Telephone Number : 352-435-4631
Provider Enumeration Date : 10/07/2010
Last Update Date : 07/31/2012

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Directions to “UPPER ROOM COUNSELING CENTER, INC. ” Practice Location

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