MEDICARE: KARINA PRIEST COUNSELING CENTER

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1225805690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARINA PRIEST COUNSELING CENTER

Provider Business Mailing Address
First Line	:	1971 SW YELLOWTAIL AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2479
Country	:	US
Telephone Number	:	561-329-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SW SAINT LUCIE WEST BLVD STE 110
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1735
Country	:	US
Telephone Number	:	561-329-4515
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KARINA PRIEST
Credential	:	LMHC
Telephone Number	:	561-329-4515

Provider Enumeration Date	:	12/06/2023
Last Update Date	:	12/06/2023

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