Healthcare Provider Details

I. General information

NPI: 1073255279
Provider Name (Legal Business Name): ASCENT CHRISTIAN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N FERDON BLVD
CRESTVIEW FL
32536-2157
US

IV. Provider business mailing address

4680 LOVEGRASS LN
CRESTVIEW FL
32539-8357
US

V. Phone/Fax

Practice location:
  • Phone: 850-603-0941
  • Fax:
Mailing address:
  • Phone: 850-603-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER ALLEN
Title or Position: OWNER/LICENSED MENTAL HEALTH COUN.
Credential: LMHC
Phone: 850-603-0941