MEDICARE: COUNSELING FOR GROWTH & HEALING 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

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	03184540	OTHER		AETNA

General Provider Information

NPI Number	:	1942768155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING FOR GROWTH & HEALING LLC

Provider Business Mailing Address
First Line	:	5700 MEMORIAL HWY STE 111
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-5221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 MEMORIAL HWY STE 111
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-5221
Country	:	US
Telephone Number	:	813-422-0896
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ROSEMARIE MILLER
Credential	:	LMHC
Telephone Number	:	813-422-0896

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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