MEDICARE: PROFESSIONAL CHRISTIAN COUNSELING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1538217740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL CHRISTIAN COUNSELING

Provider Business Mailing Address
First Line	:	1608 SMITH ST
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4819
Country	:	US
Telephone Number	:	904-278-8722
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 SMITH ST
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4819
Country	:	US
Telephone Number	:	904-278-8722
Fax Number	:	904-278-4880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TOBY D HOLLEY
Credential	:	LMHC
Telephone Number	:	904-278-8722

Provider Enumeration Date	:	01/07/2007
Last Update Date	:	11/29/2023

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