MEDICARE: LG 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1699013417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LG COUNSELING

Provider Business Mailing Address
First Line	:	6424 SW 37TH WAY
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-5137
Country	:	US
Telephone Number	:	352-210-8753
Fax Number	:	866-321-9367

Provider Business Practice Location Address
First Line	:	1521 NW 34TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-5033
Country	:	US
Telephone Number	:	352-436-1991
Fax Number	:

Authorized Official
Title or Position	:	OWNDER
Name	:	LARRY GREEN
Credential	:	LMFT
Telephone Number	:	352-210-8753

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/29/2013

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Directions to “LG COUNSELING ” Practice Location

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