MEDICARE: AFFINITY COUNSELING 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1730726811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	2101 VISTA PKWY
Second Line	:	SUITE 235
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411
Country	:	US
Telephone Number	:	561-856-5620
Fax Number	:

Provider Business Practice Location Address
First Line	:	13133 ORANGE GROVE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-8422
Country	:	US
Telephone Number	:	561-856-5620
Fax Number	:	561-623-5465

Authorized Official
Title or Position	:	CLINICAL MENTAL HEALTH COUNSELOR
Name	:	YOHAIRA M FAJARDO
Credential	:	LMHC
Telephone Number	:	561-856-5620

Provider Enumeration Date	:	12/07/2019
Last Update Date	:	12/07/2019

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