Healthcare Provider Details

I. General information

NPI: 1003277971
Provider Name (Legal Business Name): ORANGE AVENUE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9344 LAKE FISCHER BLVD
GOTHA FL
34734-5203
US

IV. Provider business mailing address

9344 LAKE FISCHER BLVD
GOTHA FL
34734-5203
US

V. Phone/Fax

Practice location:
  • Phone: 812-483-4775
  • Fax:
Mailing address:
  • Phone: 812-483-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATALEE RHODES SUMMERS
Title or Position: REG. MENTAL HEALTH COUNSELOR INTERN
Credential:
Phone: 812-483-4775