MEDICARE: WEBB - RAUCKHORST 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	106H00000X	Marriage & Family Therapist	1816	FL
2	1041C0700X	Clinical Social Worker	5457	FL

General Provider Information

NPI Number	:	1972821627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBB - RAUCKHORST COUNSELING, LLC

Provider Business Mailing Address
First Line	:	10225 ULMERTON RD STE 7A
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-3522
Country	:	US
Telephone Number	:	727-474-3740
Fax Number	:	727-474-3741

Provider Business Practice Location Address
First Line	:	10225 ULMERTON RD STE 7A
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-3522
Country	:	US
Telephone Number	:	727-474-3740
Fax Number	:	727-474-3741

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JUDY MARION RAUCKHORST
Credential	:	LCSW
Telephone Number	:	727-474-3740

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	05/05/2010

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