MEDICARE: OUR HEART 2 YOURS COUNSELING SERVICE

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

General Provider Information

NPI Number	:	1649545005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR HEART 2 YOURS COUNSELING SERVICE

Provider Business Mailing Address
First Line	:	410 N DILLARD ST
Second Line	:	SUITE 104
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2853
Country	:	US
Telephone Number	:	407-347-2092
Fax Number	:	407-347-2093

Provider Business Practice Location Address
First Line	:	410 N DILLARD ST
Second Line	:	SUITE 104
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2853
Country	:	US
Telephone Number	:	407-347-2092
Fax Number	:	407-347-2093

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	DR. GREGORY THOMAS
Credential	:	PHD, MA,BS
Telephone Number	:	407-347-2092

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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