MEDICARE: FAMILY LEARNING SOLUTIONS, 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	MH5559	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801176011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY LEARNING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	65 3RD ST NW STE 201
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4638
Country	:	US
Telephone Number	:	863-293-1744
Fax Number	:	863-293-1744

Provider Business Practice Location Address
First Line	:	65 3RD ST NW STE 201
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-4638
Country	:	US
Telephone Number	:	863-293-1744
Fax Number	:	863-293-1744

Authorized Official
Title or Position	:	OWNER
Name	:	DONNA THERESE GROSSER
Credential	:	LMHC
Telephone Number	:	863-293-1744

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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