MEDICARE: NEXTEP COUNSELING AND CLINICAL SERVICES 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	251S00000X	Community/Behavioral Health Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	2036AD6563-01	FL

General Provider Information

NPI Number	:	1558752642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXTEP COUNSELING AND CLINICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	6313 CORPORATE CT STE 130
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3509
Country	:	US
Telephone Number	:	239-362-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	6313 CORPORATE CT STE 130
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3509
Country	:	US
Telephone Number	:	239-362-0144
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA RAAB
Credential	:
Telephone Number	:	239-362-0710

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	01/16/2020

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