MEDICARE: GSB COACHING

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	103TC1900X	Counseling Psychologist	PY9663	FL

General Provider Information

NPI Number	:	1891223905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GSB COACHING

Provider Business Mailing Address
First Line	:	446 STONEHENGE CIR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4746
Country	:	US
Telephone Number	:	321-408-1870
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 4TH AVE STE 200
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3112
Country	:	US
Telephone Number	:	321-327-3793
Fax Number	:	321-327-7914

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST/OWNER
Name	:	DR. GAIL DEBORAH SIMON-BOYD
Credential	:	PHD
Telephone Number	:	321-408-1870

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	06/02/2017

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Directions to “GSB COACHING ” Practice Location

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