Healthcare Provider Details

I. General information

NPI: 1033665260
Provider Name (Legal Business Name): FAMILY LIFE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HIGHWAY 27 STE 4
CLERMONT FL
34711-2411
US

IV. Provider business mailing address

210 N HIGHWAY 27 STE 4
CLERMONT FL
34711-2411
US

V. Phone/Fax

Practice location:
  • Phone: 352-708-6283
  • Fax: 352-363-2496
Mailing address:
  • Phone: 352-708-6283
  • Fax: 352-363-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3215
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA MARIE BURCHFIELD
Title or Position: LICENSE MARRIAGE & FAMILY THERAPIST
Credential: MS, LMFT
Phone: 352-708-6283