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NPI Code Detail

MEDICARE: THERACOUNSEL, INC.

MEDICARE: THERACOUNSEL, 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
11041C0700XClinical Social Worker

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K4369OTHERFLMEDICARE PART B

General Provider Information

NPI Number : 1457460339
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERACOUNSEL, INC.
Provider Business Mailing Address
First Line : 2808 NE 22ND ST
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33305-2804
Country : US
Telephone Number : 954-564-9460
Fax Number : 954-564-1371
Provider Business Practice Location Address
First Line : 2808 NE 22ND ST
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33305-2804
Country : US
Telephone Number : 954-564-9460
Fax Number : 954-564-1371
Authorized Official
Title or Position : PRESIDENT
Name : PROF. SHERRI ISSA
Credential : LCSW
Telephone Number : 954-564-9460
Provider Enumeration Date : 08/30/2006
Last Update Date : 09/22/2011

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Directions to “THERACOUNSEL, INC. ” Practice Location

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