MEDICARE: SEABREEZE HAVEN COUNSELING 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1922959600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEABREEZE HAVEN COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 4467
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-2637
Country	:	US
Telephone Number	:	480-532-2716
Fax Number	:

Provider Business Practice Location Address
First Line	:	9507 W MAGNUM DR # 4467
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-8967
Country	:	US
Telephone Number	:	480-532-2716
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH PRACTITIONER
Name	:	SANDY JANICKI
Credential	:	LAC
Telephone Number	:	480-532-2716

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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